Does Transcatheter Aortic Valve Implantation Mean the End of Surgical Aortic Valve Replacement

Since the first transcatheter aortic valve implantation (TAVI) by Cribier in France in 2002,1 over 20,000 transcatheter aortic valve procedures have been performed. In Europe, there are 2 commercially available devices: the Edwards SAPIEN Transcatheter Heart Valve (Edwards Lifesciences LLC; Irvine, Calif) and the CoreValve® Revalving® System (Medtronic, Inc.; Minneapolis, Minn) (Fig. 1).2 Adoption has been so rapid that, on estimate, almost 20% of all aortic valve replacements performed in Germany in 2010 will be done by the TAVI approach. The adoption of TAVI, to date, has taken place totally on the basis of anecdotal experience, single-center results, and registry data. The first and only randomized trial of either valve, the Partner Trial of the SAPIEN valve,3 has been completed in the United States, and the initial results—presented in September 2010—showed a 20% improvement in 1-year survival, compared with medical therapy in inoperable patients.4 Although the available experience is still limited, the procedure as it matures appears to offer promising new therapy, especially in elderly, high-risk patients in whom conventional surgical aortic valve replacement (AVR) is either not an option or a very high-risk option.