Advent of Transcatheter Aortic Valve Implantation

Aortic stenosis (AS) has increased markedly in developed countries and AS, caused by valve calcification in the elderly, will continue to increase as the aging of society accelerates.1 With a growing need for treatment of elderly patients with severe AS, Cribier et al from France succeeded in percutaneously implanting a stent-mounted aortic valve in 2001 (Figure 1).2 In 2003, the European Heart Journal reported that at least 30% of patients who should have surgery for valvular heart disease do not actually undergo surgical treatment,3 which drew great attention to percutaneous transcatheter implantation of a stent-mounted aortic valve, as done by Cribier et al, for the treatment of severely ill patients via the venous approach under local anesthesia.4 The fact that surgery is not being performed for 30% or more of patients requiring it represents the reality as it exists for treating valvular heart disease. In 2005, Grube et al implanted a self-expanding percutaneous aortic valve and published their short-term results for 25 patients the following year.5 The mechanism of AS pathophysiology and the specific methods of recent examination and treatment are well described in the literature.1,6,7 The prevalence of cases of AS in the elderly is now 5–7% in developed countries and continues to increase. AS is thought to be initiated by arteriosclerosis and inflammation, leading eventually to calcification and restricted opening of the valve with advancing age. Once symptoms of chest pain, syncope, and cardiac failure develop, the prognosis becomes significantly worse.8 Although AS resulting from a congenital bicuspid valve is usually not considered as suitable for percutaneous treatment,9 this method has nevertheless been tried in some cases.