Transcatheter aortic valve implantation: revolution and evolution 10 years on

Cardiovascular medicine has taken a while longer than most specialities to accept the benefits of a multidisciplinary team approach to managing heart disease. The seemingly perpetual quest to find a ‘winner’ between coronary artery bypass grafting versus percutaneous coronary intervention (PCI) for the treatment of multivessel disease inadvertently spawned the concept of a heart team from the SYNTAX trial1—an integrative decision-making process that attends to the absolute needs of the patient rather than the territorial boundary lines of surgeons and physicians. The embryonic transformation of transcatheter aortic valve implantation (TAVI), from a home-made prosthesis to the now widely acknowledged standard of care for those individuals with symptomatic severe aortic stenosis (AS) deemed ineligible for surgical intervention, is underpinned by the collective efforts and overall quality of an institution's heart team, indeed as much as it owes to the pioneers of this procedure who helped to revolutionise the way in which we manage aortic valve disease.2 ,3 The year 2012 was marked by the publication of encouraging 2-year results from both cohorts 1A and 1B of the Placement of AoRtic TraNscathetER valves (PARTNER) trial—the only randomised controlled trial of TAVI published in the medical literature to date.4 ,5 In line with the PARTNER US data, October 2012 saw the US Food and Drug Administration (FDA) approve the SAPIEN transcatheter heart valve (Edwards Lifesciences, Irvine, California, USA) in high-risk AS patients eligible for surgical aortic valve replacement (SAVR) using both the transfemoral and transapical routes. This followed FDA approval of the same device in the treatment of ‘inoperable’ AS in November 2011. In August 2012, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) also issued their updated guidelines on the management of valvular heart disease (see box 1).6 …