Percutaneous Implantation of Aortic Valve Prosthesis in Patients with Calcific Aortic Stenosis: Technical Advances, Clinical Results and Future Strategies

To date, one third of patients with symptomatic aortic stenosis are not operated on because of advanced age, depressed left ventricular function, or comorbidities. Whereas balloon aortic valvuloplasty can be used as a palliative treatment in this population, the hemodynamic and clinical benefits of the procedure are only temporary. With the goal of offering to this subset of patients a nonsurgical therapeutic option with improved results and longer term positive outcomes, we developed a percutaneous implantable bioprosthetic heart valve able to be inserted within the native diseased aortic valve using cardiac catheterization techniques. The first human implant was performed by our group in April 2002 using the antegrade transeptal approach. Since then, we have implanted the valve on compassionate basis in a series of nonsurgical elderly patients with end-stage aortic stenosis and multiple comorbidities, all declined by cardiac surgeons for valve replacement. This article describes the technical improvements of the device and implantation protocols, provides clinical results of the first series of patients, and outlines strategies for future development of the percutaneous heart valve.