Contemporary trans-catheter treatment of severe aortic stenosis.

INTRODUCTION Significant improvements in medical care and lifestyle in recent years have resulted in prolongation of life. Among our growing elderly population, aortic stenosis (AS) is becoming an important and increasingly prevalent condition. It is well known to have a poor prognosis once it is symptomatic and moreover is associated with significant morbidity, multiple and prolonged hospital admissions and a significant reduction in the quality of life. The prevalence of calcific, degenerative AS increases with advancing age and affects ~40% of people aged over 80 years [1]. Once AS becomes symptomatic, life expectancy decreases dramatically (Fig. 1). Until recently, the only definitive treatment for severe AS has been surgical aortic valve replacement (AVR). In the general population, the risk of conventional aortic valve surgery is low (about 3%) and even when valve replacement is associated with concurrent coronary artery by-pass grafting, the operative risk does not exceed 5%. However, the risk of aortic valve surgery is significantly higher in the elderly, who are therefore often denied treatment [2]. It is the combination of an unmet need with a desire to find lower risk and less invasive approaches that has driven the development of percutaneous valve therapy, which is now an extremely fast-growing area of cardiology. Percutaneous and minimally invasive treatment of valvular heart disease presents a very attractive option for this high risk group. In this article, we discuss the percutaneous alternatives to open valve surgery and review the currently available techniques.