Editor’s Pick: State of the Art of Aortic Valve Implantation: Indications, Outcomes, and Controversies

I would like to highlight the paper by Salinas et al. because it provides a comprehensive and exhaustive review on the state of the art of transcatheter aortic valve implantation (TAVI).  During the last decade TAVI has revolutionised the cardiovascular field and currently represents a well-established treatment strategy for selected ‘high-risk’ patients with severe aortic stenosis. Now the burning question is “Where to go from here?” as, based on the excellent results  currently obtained in clinical practice, the indications of this exciting procedure may be  rapidly expanding. Dr Fernando Alfonso

*Pablo Salinas, Luis Nombela-Franco, Pilar Jimenez-Quevedo,  Eulogio Garcia

Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
*Correspondence to salinas.pablo@gmail.com

Disclosure: No potential conflict of interest.
Received: 30.10.14 Accepted: 12.12.14
Citation: EMJ Cardiol. 2015;3[1]:10-20.

Abstract

During the last decade, transcatheter aortic valve implantation (TAVI) has become a revolution in the treatment of high-risk severe aortic stenosis (AS). Current guidelines provide a Class I indication for TAVI in inoperable AS and Class IIa indication for TAVI as an alternative to surgical repair in high-risk patients. A large amount of retrospective, prospective, and randomised data has been published covering almost  every angle of the procedure. Improved patient evaluation and selection, new devices, and technical refinements will reduce procedural complications and improve long-term outcomes. With a growing elderly population segment in the Western countries, the procedure has a bright perspective. The purpose of this review is to summarise the state of the art of TAVI procedures, including current indications, and describe procedural characteristics, as well as short and long-term outcomes. Controversial issues such as paravalvular regurgitation and stroke are discussed, as well as off-label indications. A shift towards intermediate risk AS patients, approval of some of the off-label indications, and device versus device competition are some of the future directions of the technique.

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