Transatlantic Editorial on transcatheter aortic valve replacement

Aortic stenosis (AS) is the most common acquired valve disease in elderly patients, with a prevalence of 2.8% in those 75 years or older [1]. As the general population ages [2], it is reasonable to expect that the number of patients seeking treatment for AS also will increase in the coming years. Surgical aortic valve replacement (SAVR) remains the most effective treatment for AS and can be performed with excellent results [3–7]. However, elderly patients increasingly are presenting with multiple comorbidities, making them either high- or extreme-risk surgical candidates. Transcatheter aortic valve replacement (TAVR) was developed as an alternative to SAVR for patients at high operative risk. Since the introduction of this transformative technology in 2002, TAVR has been found to be superior to standard medical therapy at 5 years in inoperable patients [8]. In addition, mid-term results have revealed that TAVR is equivalent or has superior survival compared with SAVR in high-risk operative patients [9, 10]. These findings, combined with the minimal invasive nature of TAVR, have resulted in an explosion in the number of these procedures performed in North America and Europe [11, 12]. A similar marked experience in the number of TAVR-related clinical studies also has been observed in the last few years, with several recent clinical trials even investigating the use of TAVR in intermediate- and low-risk patients [13, 14].

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