Clinical Outcomes and Prognosis of Transcatheter Aortic Valve Interventions

Dear Colleagues,

The advent of transcatheter aortic valve implantation has fundamentally changed the management of heart valve disease. In addition to surgical aortic valve replacement, it has added another option for the treatment of patients presenting especially with aortic valve stenosis. Initial studies have investigated the value of transcatheter techniques in patients with prohibitive and very high risk for conventional surgery and have documented favorable outcomes compared to standard treatment. Transcatheter aortic valve implantation has broadened the spectrum of patients suitable for the treatment of aortic valve stenosis with subsequent trials comparing surgical and interventional treatment options in patients with lower risk profiles showing promising results for the less-invasive catheter-based approach. Besides patients presenting with aortic valve stenosis, transcatheter techniques were refined for patients with bicuspid aortic valve pathologies, aortic valve insufficiency, and ultimately endocarditis. Furthermore, a growing body of evidence shows encouraging results regarding the long-term durability of transcatheter aortic valve prostheses.

During the past decades, the surgical approach for the treatment of aortic valve pathologies was basically challenged putting initial postoperative results and long-term outcomes into question. Less-invasive transcatheter techniques are about to replace the conventional treatment as the gold standard for certain indications. Pros and cons for both treatment options need to be analyzed in a well-balanced manner and guideline recommendations must be adjusted in the light of current results for the different subsets of patient cohorts. Both, the analysis and the adjustment should incorporate all members of the heart team with prime consideration being the benefit for the patient.

Dr. Elmar W. Kuhn and Dr. Matti Adam

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