Transcatheter aortic valve implantation in 2015

The last decade has seen transcatheter aortic valve implantation (TAVI) emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical aortic valve replacement (SAVR). This position is supported by three important multicentre randomized trials comparing TAVI to the historical gold standard therapies: (1) The Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (PARTNER) IB Trial compared TAVI (Edwards SAPIEN, Edwards Lifesciences Inc., Irvine, CA) to optimal medical therapy in patients at excessive surgical risk, and demonstrated an absolute mortality reduction of > 20% at 1-year, an effect that was maintained out to 5-year follow-up; (2) The PARTNER 1A Trial compared TAVI (Edwards SAPIEN, Edwards Lifesciences Inc., Irvine, CA) and SAVR in patients at high operative risk, and found no significant differences in either clinical outcomes or valve function at five years; (3) The CoreValve (CoreValve, Medtronic Inc., Minneapolis, MN) U.S. Pivotal Trial compared TAVI and SAVR, and demonstrated significantly reduced mortality among patients treated percutaneously (22.2%), compared to those treated with SAVR (28.6%; log-rank test P < 0.05) at two years. These strong data have resulted in TAVI being used in hundreds of thousands of patients worldwide, and incorporated into the guidelines for the management of valvular heart disease from both the European Society of Cardiology and the American Heart Association / American College of Cardiology. The excellent aforementioned clinical results were achieved with first generation TAVI devices, which were far from perfect. Important limitations of first generation