Transapical aortic valve implantation: a reasonable therapeutic option, but not the only alternative to transfemoral approach

Since the first human transcatheter aortic valve implantation (TAVI) performed in April 2002 by Alain Cribier in Rouen, France (1), more than 60,000 procedures have been performed worldwide using the Edwards Lifesciences transcatheter heart valves (THV) or the Medtronic CoreValve. Before the TAVI era approximately 30-40% of patients with a class I indication for an aortic valve replacement were left untreated (2). Therefore the combination of this unmet clinical need with the desire to find a less invasive treatment than conventional surgery has driven the development of TAVI. As a result of the important effort of the engineers and medical community and following the results of the prospective multicenter randomized PARTNER trials (3,4) in a decade TAVI has become standard treatment for patients who are unsuitable (cohort B) or seen as high-risk for surgical aortic valve replacement (cohort A).