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Eur J Cardiothorac Surg 2007;31:7-8. doi:10.1016/j.ejcts.2006.11.003
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Editorials

Transapical transcatheter aortic valve implantation

Department of Cardiovascular Surgery, Albert-Ludwigs-University of Freiburg, Germany

Received 4 November 2006; received in revised form 4 November 2006; accepted 5 November 2006.

^_* Corresponding author. (Email: friedhelm.beyersdorf@uniklinik-freiburg.de).

The first 20% of the full text of this article appears below.

Modern surgical treatment for aortic valve disease has undergone significant improvements in all areas of this procedure including the surgical techniques, durability of bioprothetic valves, techniques for myocardial protection, extracorporeal circulation, intraoperative echocardiography, anaesthesia, postoperative intensive care, as well as significant reduction in intensive care and hospital stay. This has resulted in very acceptable mortality and morbidity rates in most centers, even in high-risk patients. The major risk factors today for open heart aortic valve procedures are the number of co-morbidities of the patients and not age per se.

Despite these very promising results after aortic valve replacement (AVR), preliminary data point out that there seems to be a significant number of patients with aortic valve disease who are not referred for surgical treatment. This non-referral might be related to (a) a subjective lack of symptoms of older patients who would like to avoid open heart surgery in general and/or (b) the assumption of family physicians or cardiologists of a prohibitive operative risk, especially in older patients with several severe co-morbidities.

Balloon aortic valvuloplasty had been used as an alternative approach to non-surgical candidates. However, this treatment was associated with a high mortality and especially morbidity rate and a high return of symptoms and restenosis within months of the procedure [1] and has been abandoned.

Eventually the emerging field of endovascular stenting and the technology of integrating bioprothetic valves into a stainless steel stent has let to the transcatheter approach for AVR. After . . . [Full Text of this Article]

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