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The evolution of transcutaneous aortic valve replacement: moving in the right direction
  1. David M Shavelle
  1. Correspondence to Dr David M Shavelle, Division of Cardiovascular Medicine, Keck School of Medicine, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA; shavelle{at}usc.edu

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The introduction of the first percutaneous heart valve by Bonhoeffer in 1999, followed by the first percutaneous aortic valve in a human in 2002 by Cribier and colleagues marked the beginning of an era for patients with advanced valve disease.1 ,2 Transcatheter aortic valve replacement (TAVR) now offers the ability to treat otherwise ‘non-operable’ and high-risk patients with aortic stenosis. To date, more than 50 000 TAVR procedures have been performed worldwide with newer valve systems entering clinical trials.3 Pivotal randomised trials, including The Placement of AoRTic TraNscathetER Valve (PARTNER) Trials and the recently reported Medtronic CoreValve United States Pivotal Trial, have shown the benefit of this therapy in high-risk and non-operable patients with 1-year mortality rates of 24.2% and 30.7%, respectively.4 ,5 These impressive findings have also been confirmed in large-scale registry data from the UK and Europe with high procedural success, low stroke rates and acceptable 1-year mortality.6

Imaging with transoesophageal echocardiography

Prior to the implant procedure, accurate measurements of the aortic annulus diameter and perimeter are required in order to select the appropriate valve size.7 During the procedure, both the balloon …

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