[TAVI: History and perspectives]. / TAVI : histoire et perspectives.

Nearly 20 years have passed from the concept to clinical development of percutaneous aortic valve replacement, starting from an idea considered "stupid" of Professor Alain Cribier in Rouen. After a first phase of compassionate implantation, large randomized trials PARTNER and COREVALVE US have allowed TAVI to impose itself in the European and American recommendations in patients inoperable or considered with high surgical risk. Next European recommendations on the management of valvular heart diseases expected in 2017 should take into account the positive results observed in intermediate risk patients in the PARTNER 2 and SURTAVI studies, recently adopted in the US recommendations. Randomized trials in "all coming" patients are already on their way, and the future of TAVI is to be the reference treatment for a vast majority of patients with aortic stenosis.

Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status.

Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction. The advent in France of transcatheter aortic valve replacement has raised the hope in the United States for an alternative, less invasive treatment for aortic stenosis. Two recent trials-the Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (Partner) and the CoreValve US Pivotal-have established transcatheter aortic valve replacement as the preferred approach in patients who are at high or prohibitive surgical risk. The more recently published Partner 2 trial has shown the feasibility of transcatheter aortic valve replacement in intermediate-surgical-risk patients as well. With a profile that promises easier use and better valve performance and delivery, newer-generation valves have shown their potential for further improvement in safety profile and overall outcomes. We review the history and status of this topic.

Transcatheter Aortic Valve Implantation ­ History, Current Guidelines and Implications for the Future. / Der perkutane Aortenklappenersatz Geschichte, aktuelle Empfehlungen und Zukunftsausblick.

Degenerative aortic stenosis is a disease of the elderly and of growing importance in an ageing population. Due to the impaired life-expectancy of patients with symptomatic aortic stenosis, valve replacement should be performed. Surgical aortic valve replacement is the gold standard treatment; however, median sternotomy and use of extracorporal circulation is a risk for elderly patients with comorbidities. The introduction of transcatheter aortic valve implantation (TAVI) into clinical practice has revolutionized treatment of aortic stenosis in elderly patients. In most patients, TAVI can be performed through the groin vessels using local anaesthesia. Most patients fully recover within a few days. Current debate focuses on whether TAVI should also be used to treat younger patients as data on long-term durability of these valves is insufficient and there is a remaining risk of paravalvular leackage.

Transcatheter aortic valve replacement: History and current indications.

Transcatheter aortic valve replacement is an effective way to treat patients with symptomatic severe aortic valve stenosis who are deemed high risk or inoperable. Current data suggest that the mortality and stroke rates are acceptable compared to surgical aortic valve replacement. There is a possible utility in moderate-risk patients as more data become available.

Transcatheter Aortic Valve Implantation - Yesterday, Today and Tomorrow.

Since the first transcatheter aortic valve implantation (TAVI) was performed by Alain Cribier and colleagues in 2002 [1], the technology has garnered global support with more than 200,000 devices implanted. The rapid adoption of this technology has been driven by the need for a less invasive treatment modality in a cohort of patients often denied conventional surgical valve replacement due to an unacceptably high perioperative risk, whether real or perceived [2]. This, together with evidence that the technology confers morbidity and mortality advantages compared to medical therapy [3,4] and at least equivalent outcomes to surgical valve replacement [5,6] in select cohorts, has seen clinical approval in more than 50 countries. The last 13 years has seen an evolution of practises and equipment affecting almost every aspect of the TAVI procedure from pre-procedural assessment to device design and post-procedural care. The almost exponential rate of change has both benefits and risks. Benefits, in that impactful changes are translated into clinical practice very rapidly, but risks, in that meaningful comparative research studies potentially lag behind and can be outmoded by the time they are published. This instability may in turn delay regulatory review and approval processes that are based on such studies. The aim of this review is to provide an overview of the evolution of TAVI, its current clinical position and likely future directions.