Percutaneous aortic valve replacement

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Percutaneous aortic valve replacement
Intervention
ICD-9-CM 35.05

Percutaneous aortic valve replacement (PAVR), often transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). The replacement 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) and direct aortic (through a minimally invasive surgical incision into the aorta).

The catheter procedure was developed in France, initially performed in 2002 on April 16 by Prof Alain Cribier in Hopital Charles Nicolle, in Rouen.[1] It is now approved in more than 50 countries. It is effective in improving functioning in the patients with severe aortic stenosis. In the US, it received FDA approval in November 2011 for use in inoperable patients and in October 2012 for use in patients at high surgical risk.[2]

In high-risk patients with severe aortic stenosis, transcatheter and surgical procedures for aortic-valve replacement had similar rates of survival at 1 year, although there were important differences in risks associated with the procedure.[3][unreliable medical source?]

In 2010 good results (20% better 1 year survival) were reported from a US trial on 358 patients.[4][unreliable medical source?]

Devices[edit]

There are two current market leaders whose devices have earned CE Mark approval in Europe and are available to physicians for implantation in appropriate patients; the Medtronic CoreValve device (a self-expanding valve prosthesis consisting of a Nickel-titanium frame with a tri-leaflet valve fashioned out of porcine pericardium mounted within) and the SAPIEN device by Edwards Lifesciences (a balloon-expandable tubular metal stent with a tri-leaflet valve fashioned out of bovine pericardium mounted within). The Medtronic CoreValve received FDA approval on January 17, 2014.[5]

References[edit]

  1. ^ Cribier, A; Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB (10 December 2002). "Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. First human case description.". Circulation 106 (24): 3006–3008. PMID 12473543. 
  2. ^ http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm278348.htm
  3. ^ Smith, Craig R.; et al. (2 June 2011). "Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients". N Engl J Med 364: 2187–2198. doi:10.1056/NEJMoa1103510. PMID 21639811. 
  4. ^ "New Procedure for Aortic Valve Replacement Looks Promising". 22 September 2010. 
  5. ^ FDA Approves Medtronic's CoreValve Heart Device

Further reading[edit]