Skip to main content
SpringerLink
Log in

Development of Aortic Valve Implantation

Entwicklung der Aortenklappenimplantation

  • Published:
Herz Kardiovaskuläre Erkrankungen Aims and scope Submit manuscript

Abstract

Aortic valve stenosis is an important public-health problem in Europe and is predicted to increase with the aging population. Management of severe symptomatic aortic stenosis is by surgical replacement of the aortic valve whenever feasible. Improvement in the perioperative management has permitted surgical intervention in high-risk patients. However, patients refused surgery can now be managed by transcatheter techniques. These have opened new horizons for patients for whom conventional surgery is contraindicated or the technical complexity of the procedure is associated with considerable operative risk. The development of transcatheter aortic valve implantation, available technology, choice of approach, and future perspectives are discussed.

Zusammenfassung

Die Aortenklappenstenose ist ein bedeutendes allgemeines Gesundheitsproblem in Europa, das sich mit Zunahme der alternden Bevölkerung voraussichtlich noch erhöhen wird. Die Behandlung der schweren symptomatischen Aortenstenose besteht bei geeigneten Patienten im chirurgischen Ersatz der Aortenklappe. Verbesserungen im perioperativen Management erlauben die chirurgische Intervention bei Hochrisikopatienten. Jedoch können jetzt auch Patienten, denen ein chirurgischer Eingriff verweigert wird, mit Transkatheter-Techniken behandelt werden. Diese haben neue Horizonte für Patienten eröffnet, bei denen die konventionelle Chirurgie kontraindiziert oder die technische Komplexität des Verfahrens mit einem beträchtlichen Operationsrisiko verbunden ist. Die Entwicklung der kathetergesteuerten Aortenklappenimplantation, die verfügbare Technologie, die Wahl des Zugangs und die Zukunftsperspektiven werden besprochen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003; 24:1231–43.

    Article  PubMed  Google Scholar 

  2. Lindroos M, Kupari M, Heikilla J. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993;21:1220–5.

    Article  PubMed  CAS  Google Scholar 

  3. US Bureau of the Census. Statistical abstract of the United States/2006, 12th edn. Washington: Department of Commerce, 2006.

    Google Scholar 

  4. Varadarajan P, Kapoor N, Bansal RC, et al. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg 2006;82:2111–5.

    Article  PubMed  Google Scholar 

  5. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease. The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007;28:230–68.

    PubMed  Google Scholar 

  6. Mihaljevic T, Nowicki ER, Rajeswaran J, et al. Survival after valve replacement for aortic stenosis: implications for decision making. J Thorac Cardiovasc Surg 2008;135:1270–8.

    Article  PubMed  Google Scholar 

  7. STS National Database. STS US Cardiac Surgery Database: 1997 aortic valve replacement patients: preoperative risk variables. Chicago: Society of Thoracic Surgeons, 2000 (http://www.ctsnet.org/doc/3031).

    Google Scholar 

  8. Nowicki ER, Birkmeyer NJ, Weintraub RW, et al., Northern New England Cardiovascular Disease Study Group and the Center for Evaluative Clinical Sciences, Dartmouth Medical School. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. Ann Thorac Surg 2004;77:1966–77.

    Article  PubMed  Google Scholar 

  9. Bouma BJ, van Den Brink RB, Zwinderman K, et al. Which elderly patients with severe aortic stenosis benefit from surgical treatment? An aid to clinical decision making. J Heart Valve Dis 2004;13:374–81.

    PubMed  Google Scholar 

  10. Iung B, Cachier A, Baron G, et al. Decision making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005;26:2714–20.

    Article  PubMed  Google Scholar 

  11. Langanay T, De Latour B, Ligier K, et al. Surgery for aortic stenosis in octogenarians: influence of coronary disease and other comorbidities on hospital mortality. J Heart Valve Dis 2004;13:545–52.

    PubMed  Google Scholar 

  12. Florath I, Rosendahl UP, Mortasawi A, et al. Current determinants of operative mortality in 1400 patients requiring aortic valve replacement. Ann Thorac Surg 2003;76:75–83.

    Article  PubMed  Google Scholar 

  13. Cribier A, Saoudi N, Berland J, et al. Percutaneous trans-luminal valvuloplasty of acquired aortic-stenosis in elderly patients - alternative to valve-replacement. Lancet 1986;1:63–7.

    Article  PubMed  CAS  Google Scholar 

  14. Eltchaninoff H, Cribier A, Tron C, et al. Balloon aortic valvuloplasty in elderly patients at high-risk for surgery, or inoperable-immediate and mid-term results. Eur Heart J 1995; 16:1079–84.

    PubMed  CAS  Google Scholar 

  15. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002;106:3006–8.

    Article  PubMed  Google Scholar 

  16. De Jaegere P, Van Dijk LC, Laborde JC, et al. True percutaneous implantation of the CoreValve aortic valve prosthesis by the combined use of ultrasound guided vascular access, Prostar® XL and the TandemHeart®. EuroIntervention 2007;8:500–5.

    Google Scholar 

  17. Bleiziffer S, Ruge H, Mazzitelli D, et al. Results of percutaneous and transapical transcatheter aortic valve implantation performed by a surgical team. Eur J Cardiothorac Surg 2009;35:615–20.

    Article  PubMed  Google Scholar 

  18. Bojara W, Mumme A, Gerckens U, et al. Implantation of the CoreValve self-expanding valve prosthesis via a subclavian artery approach: a case report. Clin Res Cardiol 2009;98: 201–4.

    Article  PubMed  Google Scholar 

  19. Kempfert J, Walther T, Borger MA, et al. Minimally invasive off-pump aortic valve implantation: the surgical safety net. Ann Thorac Surg 2008;86:1665–8.

    Article  PubMed  Google Scholar 

  20. Walther T, Dewey T, Borger MA, et al. Transapical aortic valve implantation: step by step. Ann Thorac Surg 2009; 87:276–83.

    Article  PubMed  Google Scholar 

  21. Vahanian A, Alfieri OR, Al-Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2008;34:1–8.

    Article  PubMed  Google Scholar 

  22. Roques F, Nashef SA, Michel P, et al. Risk factors and outcome in European cardiac surgery: analysis of the Euro SCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999;15:816–22.

    Article  PubMed  CAS  Google Scholar 

  23. http://www.209.220.160.181/STSWebRiskCalc261/.

  24. Dewey TM, Brown D, Ryan WH, et al. Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement. J Thorac Cardiovasc Surg 2008;135:180–7.

    Article  PubMed  Google Scholar 

  25. Osswald BR, Gegouskov V, Badowski-Zyla D, et al. Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement. Eur Heart J 2009;30:74–80.

    Article  PubMed  Google Scholar 

  26. Al-Attar N, Himbert D, Descoutures F, et al. Transcatheter aortic valve implantation: selection strategy is crucial for outcome. Ann Thorac Surg 2009;87:1757–62.

    Article  PubMed  Google Scholar 

  27. Grube E, Schuler G, Buellesfeld L, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis. Device success and 30-day clinical outcome. J Am Coll Cardiol 2007;50:69–76.

    Article  PubMed  Google Scholar 

  28. Walther T, Falk V, Kempfert J, et al. Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J Cardiothorac Surg 2008;33:983–8.

    Article  PubMed  Google Scholar 

  29. Ye J, Cheung A, Lichtenstein SV, et al. Six-month outcome of transventricular transcatheter aortic valve implantation in the initial seven patients. Eur J Cardiothorac Surg 2007; 31:16–21.

    Article  PubMed  Google Scholar 

  30. Hannan EL, Samadashvili Z, Lahey SJ, et al. Aortic valve replacement for patients with severe aortic stenosis: risk factors and their impact on 30-month mortality. Ann Thorac Surg 2009;87:1741–9.

    Article  PubMed  Google Scholar 

  31. Zierer A, Wimmer-Greinecker G, Martens S, et al. The transapical approach for aortic valve implantation. J Thorac Cardiovasc Surg 2008;136:948–53.

    Article  PubMed  Google Scholar 

  32. Svensson LG, Dewey T, Kapadia S, et al. United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex. Ann Thorac Surg 2008; 86:46–54.

    Article  PubMed  Google Scholar 

  33. Al-Attar N, Raffoul R, Himbert D, et al. False aneurysm after transapical aortic valve implantation. J Thorac Cardiovasc Surg 2009;1:e21–2.

    Article  Google Scholar 

  34. Al-Attar N, Ghodbane W, Himbert D, et al. Unexpected complications of transapical aortic valve implantation. Ann Thorac Surg 2009; 88:90–4.

    Article  PubMed  Google Scholar 

  35. Walther T, Falk V, Dewey T, et al. Valve-in-a-valve concept for transcatheter minimally invasive repeat xenograft implantation. J Am Coll Cardiol 2007;50:56–60.

    Article  PubMed  Google Scholar 

  36. Serruys PW. Keynote address - EuroPCR 2008, Barcelona, May 14th, 2008. Transcatheter aortic valve implantation: state of the art. EuroIntervention 2009;4:558–65.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiovascular Surgery, Bichat – Claude Bernard Hospital, University Paris 7 Denis Diderot, Paris, France

    Nawwar Al-Attar & Patrick Nataf MD, FETCS

  2. Department of Cardiac Surgery, Bichat Hospital, 46 rue Henri Huchard, 75018, Paris, France

    Patrick Nataf MD, FETCS

Authors
  1. Nawwar Al-Attar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Nataf MD, FETCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Nataf MD, FETCS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Attar, N., Nataf, P. Development of Aortic Valve Implantation. Herz 34, 367–373 (2009). https://doi.org/10.1007/s00059-009-3259-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-009-3259-9

Key Words:

Schlüsselwörter:

Search

Navigation