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).

AIMS To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. METHODS AND RESULTS A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindications for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation. CONCLUSION Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusion.

[1]  Karla Lindquist,et al.  Development and validation of a prognostic index for 4-year mortality in older adults. , 2006, JAMA.

[2]  Jeroen J. Bax,et al.  Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. , 2008, JACC. Cardiovascular imaging.

[3]  Assaf Bash,et al.  Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. , 2004, Journal of the American College of Cardiology.

[4]  P. Serruys,et al.  True percutaneous implantation of the CoreValve aortic valve prosthesis by the combined use of ultrasound guided vascular access, Prostar(R) XL and the TandemHeart(R). , 2007, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[5]  Philippe Ravaud,et al.  Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? , 2005, European heart journal.

[6]  Bram D. Zuckerman,et al.  The FDA role in the development of percutaneous heart valve technology , 2006 .

[7]  Lukas Altwegg,et al.  Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis , 2007, Circulation.

[8]  T. Vassiliades,et al.  The clinical development of percutaneous heart valve technology: a position statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI). , 2005, The Annals of thoracic surgery.

[9]  R. Moss,et al.  Role of echocardiography in percutaneous aortic valve implantation. , 2008, JACC. Cardiovascular imaging.

[10]  P. Kolh,et al.  Aortic valve surgery in octogenarians: predictive factors for operative and long-term results. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[11]  Y. Castier,et al.  Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly. , 2008, European heart journal.

[12]  Anson Cheung,et al.  Transapical Transcatheter Aortic Valve Implantation in Humans: Initial Clinical Experience , 2006, Circulation.

[13]  G. Grunkemeier,et al.  Prosthetic heart valves: Objective Performance Criteria versus randomized clinical trial. , 2006, The Annals of thoracic surgery.

[14]  S. Nashef,et al.  Risk factors for early mortality after valve surgery in Europe in the 1990s: lessons from the EuroSCORE pilot program. , 2001, The Journal of heart valve disease.

[15]  Helmut Baumgartner,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 , 2007 .

[16]  Philippe Ravaud,et al.  A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. , 2003, European heart journal.

[17]  M. Mack,et al.  Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement. , 2008, The Journal of thoracic and cardiovascular surgery.

[18]  Patrick Royston,et al.  Generic, Simple Risk Stratification Model for Heart Valve Surgery , 2005, Circulation.

[19]  E. DeLong,et al.  Prediction of operative mortality after valve replacement surgery. , 2001, Journal of the American College of Cardiology.

[20]  Thomas Walther,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. , 2007, Journal of the American College of Cardiology.

[21]  A. Cribier,et al.  Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow-up from the initial feasibility studies: the French experience. , 2006, Journal of the American College of Cardiology.

[22]  M. Pasque,et al.  Aortic valve replacement in octogenarians: risk factors for early and late mortality. , 2007, The Annals of thoracic surgery.

[23]  Volkmar Falk,et al.  Minimally invasive transapical beating heart aortic valve implantation--proof of concept. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[24]  Assaf Bash,et al.  Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis: First Human Case Description , 2002, Circulation.

[25]  Ghassan Sleilaty,et al.  Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults. , 2008, Journal of the American College of Cardiology.

[26]  Thomas A Vassiliades,et al.  The clinical development of percutaneous heart valve technology. , 2005, The Journal of thoracic and cardiovascular surgery.

[27]  A. Cheung,et al.  Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[28]  M. Mack,et al.  Transapical minimally invasive aortic valve implantation , 2007 .

[29]  M. Cheitlin.  Percutaneous Aortic Valve Implantation Retrograde From the Femoral Artery , 2007 .

[30]  E. Schelbert,et al.  Hospital Volume and Selection of Valve Type in Older Patients Undergoing Aortic Valve Replacement Surgery in the United States , 2005, Circulation.

[31]  Thomas Felderhoff,et al.  Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease: The Siegburg First-in-Man Study , 2006 .

[32]  J. Gardin,et al.  Burden of valvular heart diseases: a population-based study , 2006, The Lancet.