Applicability, basic techniques and current status—‘the essential ABCs’—of transcatheter aortic valve replacement (TAVR)

Aortic stenosis is the most common valvular heart disease in the elderly which warrants immediate intervention due to the poor outcomes in untreated patients. Even though the procedure of choice is surgical aortic valve replacement (SAVR) in good risk patients, transcatheter aortic valve replacement (TAVR) is evolving as a standard of care in extreme high-risk patients. Encouraging results are obtained by proper patient selection by a heart team. Transoesophageal echocardiogram and TAVR CT scan-based sizing and deployment strategies have yielded good results. Though transfemoral is the preferred route of deployment, alternate access route like trans apical, transcaval and transaortic routes has resulted in extending this modality of treatment to patients with aortoiliac occlusive disease. Self expanding and balloon expandable valves have been licenced for human use in indicated patients in the USA and in Europe. Increasing expertise, recapturement ability, and reduction is the sheath size has resulted in fewer complications. Durability of transcatheter valves need further evaluation. Trials like PARTNER 2 and SURTAVI are currently being undertaken to improve the existing technology and to expand the indications of TAVR.