As the elderly population has grown, so symptomatic aortic stenosis has become an increasing problem with a poor prognosis if untreated (1,2). Trans-catheter aortic valve implantation (TAVI) has been designed to treat patients who would be at high risk during standard cardiac surgery. TAVI allows aortic valve implantation without the need for a sternotomy or cardiopulmonary bypass. The procedure may be performed from the femoral or trans-apical approach depending on the calibre of the peripheral vascular vessels and the device being used. The first human procedure was performed in 2002 and recently two devices have received a CE mark. The Edwards Sapien Valve and the Corevalve are now available for commercial use in the UK. The Edwards valve is a balloon expandable valve delivered either from the transfemoral or transapical (left 5th/6th intercostals space) approach while the Corevalve is a self-expanding device which currently can only be delivered by the transfemoral or trans-axillary approach. The procedure is usually (but not always) carried out under a general anaesthetic and during the trans-femoral approach the femoral artery is usually (but not always) closed by an open surgical technique.
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