Special Issue Article
Cardiac Surgery: Current Status of Aortic Valve Replacement
Tarek Malas and Marc Ruel*
Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada
- *Corresponding Author:
- Marc Ruel
Division of Cardiac Surgery, University of Ottawa Heart Institute
40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7
E-mail: [email protected]
Received date: June 18, 2012; Accepted date: July 23, 2012; Published date: July 24, 2012
Citation: Malas T, Ruel M (2012) Cardiac Surgery: Current Status of Aortic Valve Replacement. Surgery S3:001 doi:10.4172/2161-1076.1000S3-001
Copyright: © 2012 Malas T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Aortic Stenosis (AS) is present in approximately 2% of people and is most commonly caused by degenerative calcification of the aortic valve. Without aortic valve intervention, aortic stenosis is associated with substantial morbidity and mortality in patients, particularly in those presenting with angina, syncope, or heart failure.
The current gold standard for treatment of Aortic Stenosis is surgical aortic valve replacement, most commonly with either a mechanical or a bioprosthetic aortic valve. The choice of valve prosthesis is dependent on a myriad of factors involving patient preferences, age, life expectancy, presence of other comorbidities, and contraindications to lifelong anticoagulation. Although surgeons have traditionally recommended mechanical valves for patients younger than 60 for their long-term durability, studies have demonstrated that there was no significant difference in long-term survival for tissue versus mechanical aortic prosthesis for patients younger than 60 years.
A large proportion of patients deemed high-risk for surgical valve replacement have been successfully treated with percutaneous deployment of an aortic valve by Transcatheter Aortic Valve Implantation (TAVI) technologies in a less invasive method. TAVI devices have shown immense success in the clinical realm via both the transfemoral and transapical approaches. The PARTNER trial investigators have demonstrated in their first cohort of patients that transfemoral TAVI was superior to standard medical therapy in reducing any-cause mortality, cardiovascular mortality, and repeat hospitalization. Furthermore, a comparison of TAVI to surgical aortic valve replacement (SAVR) in specific high-risk populations of patients in the PARTNER trial demonstrated non-inferiority of TAVI compared to SAVR. While TAVI has shown success in a large group of patients, its limitations and its long-term outcomes are being explored in a range of studies. Currently, surgical AVR is still the gold standard for treatment of aortic stenosis, but percutaneous TAVI technology continues to play a key role in management of aortic stenosis in certain subpopulations of patients.