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A Journal on Heart and Vascular Diseases

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2014 April;62(2):193-203

language: English

New perspectives for transcatheter aortic valve implantation: more than a “simple” alternative to surgery

Niglio T. 1, Galasso G. 1, Piccolo R. 1, Di Gioia G. 1, Strisciuglio T. 1, Esposito G. 1, Trimarco B. 1, Piscione F. 2

1 Department of Advanced Biomedical Sciences Federico II University, Naples, Italy;
2 Department of Medicine and Surgery University of Salerno, Salerno, Italy


To date, the gold standard of aortic stenosis treatment is surgical valve replacement. However, in inoperable or high risk patients a valid alternative is transcatheter aortic valve implantation (TAVI). Several trials showed feasibility, efficacy and safety of TAVI, with a tailored strategy for these patients on the basis of their clinical and anatomical conditions. The selection of valve type (CoreValve® or Edwards Sapien®) and transcatheter approach (transfemoral, transapical, subclavian or direct aortic approach) is an important step in the management of aortic stenosis. However, mortality is high and it is mainly related to non-cardiac reasons, given the high clinical risk profile of these patients. Moreover, the less invasive approach, the faster recovery, the reduced morbidity and the improved psychological tolerance, typical of TAVI, suggest that this technique could be used in a broader spectrum of cases, becoming a valid therapeutic alternative even in patients with severe aortic stenosis with a low surgical risk or asymptomatics. The identification of aortic stenosis patients by the medical community and their assessment over time, before they become candidates only for “extreme” strategies, remains the main challenge.

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