Transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) was developed as a potential therapy for patients with severe symptomatic aortic stenosis and deemed high-risk for surgical aortic valve replacement (SAVR). The first TAVR was done less than 2 decades ago and since then has transformed how these patients are treated. Presently, TAVR is approved for those patients declared at least intermediate risk by a multi-disciplinary heart team. Soon, it is very likely that the indication for TAVR will include low-risk patients as well. As the indication for the therapy has evolved, the various TAVR technologies have gone through several iterations. Originally, large bore devices frequently requiring alternative access (not trans-femoral arterial) with high vascular complication rates have now become much lower profile delivery systems, almost universally done trans-femoral, with vascular complications <10%. This chapter will summarize the evolution of the TAVR technology, including clinical data and specific devices. If the current clinical trials demonstrate TAVR’s long-term durability, it will become the treatment of choice for symptomatic severe aortic stenosis in all patients anatomically suitable for TAVR who are candidates for a tissue valve.