Exciting News on TAVR; Tempered by Unanswered Questions

Svensson_LarsThis post was authored by Lars G. Svensson, MBBCH, PhD, FACC, chair of the Sydell and Arnold Miller Family Heart and Vascular Institute at Cleveland Clinic in Cleveland, OH.

There are few procedures that show a benefit for patients relieving symptoms, saving lives, and improving long-term survival as aortic valve replacement (AVR). Indeed, the advent of transcatheter aortic valve replacement (TAVR) hailed a new era for valve replacement.

In 2001, Alain Cribier, MD, FACC, pioneered human implantation of percutaneous aortic valve replacement via the femoral vein, however this proved to be too high risk. The transapical approach was then implemented with a moderate risk, but shortly thereafter the transfemoral arterial approach was developed with considerably lower mortality although with complications. For example, there was about a 20 percent failure rate from failure to implant, embolization and severe perivalvular regurgitation. Nevertheless, studies in high-risk patients (PARTNER cohort A and PARTNER cohort B) showed excellent outcomes for TAVR with equivalence to open surgery.

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