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Aortic stenosis (AS), which is now the most frequent native valve disease in Europe, has a predominantly degenerative origin and is mostly seen in elderly patients. Valve replacement is the definitive therapy1; however, the risk of surgery is high in elderly patients with significant comorbidities.2 In addition, several registries show that as many as one third of patients with severe valve disease and severe symptoms are not being considered for surgery.3 Thus, there is a role for less invasive alternatives. Balloon aortic valvuloplasty (BAV) is now rarely used in isolation, mainly due to its limited long term efficacy.
Seven years after its introduction in clinical practice by Alain Cribier,4 transcatheter aortic valve implantation (TAVI) currently represents a dynamic field of research and development.
Two devices are commercially available for TAVI (figure 1). One device is the Edwards-Sapien valve, which consists of three bovine pericardial leaflets, mounted within a tubular, slotted, stainless steel, balloon expandable stent. It is currently available in 23 and 26 mm sizes, necessitating, respectively, 22F and 24F introducer sheaths for the transfemoral approach and 26F for the transapical approach. The other device is the Medtronic CoreValve which has three porcine pericardial leaflets (initially bovine) mounted in a self expanding nitinol frame. It is available in 26 and 29 mm sizes, which go through an 18F introducer for transfemoral or transaxillary use.
The selection of candidates for TAVI and the performance of the procedure require the cooperation of a multidisciplinary team including cardiologists, surgeons, imaging specialists and anaesthetists, all with experience in the management of valve disease.5
This review will …