Surgical aortic valve replacement (AVR) was first developed in the 1960s. The procedure rapidly became first-line therapy for the management of symptomatic severe aortic stenosis (AS). Concurrently, percutaneous catheter-mounted valves were evaluated in animals, although these did not make it into clinical use. In the 1980s, balloon aortic valvuloplasty appeared as an alternative to AVR. However, despite short-term symptomatic relief and improved haemodynamics, valvuloplasty did not change the natural course of the disease. Collapsible metal scaffolds with biological valves for permanent implantation were investigated in animal models in the early 1990s. In 2002, the first-in-human transcatheter aortic valve implantation (TAVI) was performed via an antegrade, transvenous approach. Later, the retrograde approach, with access via the femoral artery, gained favour and became a reproducible, fully percutaneous procedure. Recently, subclavian access has also proven to be a feasible and reproducible alternative. Both the antegrade transapical and retrograde direct aortic approaches now offer alternatives for patients with unsuitable vascular access via the femoral route. Within a decade, TAVI spread throughout the world, became approved by regulatory authorities, and is now part of the armamentarium in the treatment of AS as a lifesaving, but less invasive, procedure.
- Allied Specialities