Transcatheter Aortic Valve Implantation: What Lies Ahead?

Ttranscatheter aortic valve implantation (TAVI) is currently reserved for high surgical risk or inoperable patients. There are currently two types of valves being implanted, the Medtronic Corevalve and the Edwards SAPIEN device. In 2007, TAVI actually represented approximately 1.2% of all aortic valve procedures in Europe; this percentage increased to 6.5% in 2008. With an expectation of ~9000 TAVI procedures to be performed in 2009, TAVI may represent nearly 13% of all aortic valve procedures. It is forecasted that by 2012 transcatheter valve therapies will account for approximately 40% of the total heart valve procedures performed in Europe. One major limiting factor relates to procedural complications of TAVI. Conduction abnormalities and the need for permanent pacemaker, paravalvular aortic regurgitation, stroke and vascular complications have received particular attention. After implantation of the CoreValve device, the need for new permanent pacemaker has been reported to be in the range of 19–35%. In contrast, approximately 4–7% of patients are in need of permanent pacemaker after implantation of the Edwards device. The future and widespread adoption of TAVI will rely on a number of inter-related factors, including long-term durability and safety data, randomized controlled trials comparing TAVI with surgical aortic valve replacement and reimbursement for the technology.