Transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR), or transcatheter aortic valve implantation (TAVI), is the implantation of a replacement for the aortic valve through the blood vessels and into the heart, without removing the native valve. TAVR is an alternative to surgical aortic valve replacement (SAVR), which requires open heart surgery. TAVR procedure is used to treat severe aortic stenosis. The first TAVI was performed on 16 April 2002 by Alain Cribier. The implanted valve is delivered via one of several access methods: transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta), and transcaval (from a temporary hole in the aorta near the navel through a vein in the upper leg), among others.

Severe symptomatic aortic stenosis carries a poor prognosis. At present, there is no treatment via medication, making the timing of aortic valve replacement the most important decision to make for these patients. Until recently, surgical aortic valve replacement was the standard treatment for adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure or coronary artery disease, as well as in people with comorbidities such as cerebrovascular and peripheral arterial disease, chronic kidney disease, and chronic respiratory dysfunction.