Aortic Valve Implantation – Developments and Challenges

Surgical aortic valve replacement is the reference standard for patients with symptomatic severe aortic valve stenosis, but it is associated with a high surgical risk in numerous patient subgroups who present with co-morbidities such as reduced ejection fraction, prior surgery or advanced age. Transcatheter aortic valve implantation utilising stent-based prostheses has emerged as a promising new option in recent years and has been used by a number of operators in different centres, with incremental success in line with procedural experience. This has sparked the evolution of more sophisticated techniques, ranging from the initial anterograde approach to the currently used retrograde approach utilising arterial access or a transapical approach. The technology has also significantly improved over the years, with the development of delivery catheters with smaller profiles and better prostheses with various size options. These developments in the field of transcatheter aortic valve implantation and future perspectives will be discussed in this article.