Prof. Lars SØNDERGAARD

Consultant Cardiologist
Rigshospitalet, Copenhagen
Professor of Cardiology
University of Copenhagen
Denmark

Based on the pioneering works by Henning Rud Andersen, Alain Cribier performed the first in human transcatheter aortic valve implantation (TAVI) in 2002. Subsequently, TAVI has led to a paradigm shift in the treatment of elderly patients with severe aortic stenosis. Several randomized clinical trials have demonstrated that safety of TAVI is at least non-inferior to SAVR in these patients regardless their risk profiles. This in combination with optimized pre-procedural planning, procedural steps, and patient pathway has led to expanding indications for TAVI. Furthermore, it is foreseen that also patients with e.g., longer life-expectancy, asymptomatic severe aortic stenosis, symptomatic moderate aortic stenosis, or pure aortic regurgitation may potentially be offered TAVI soon. However, treating such patients with TAVI requires further device developments as well as procedural refinements to reduce the risk of e.g., new conduction abnormalities, paravalvular leakage, and impaired access to the coronary arteries after TAVI. Furthermore, strategies for life-time management of younger patients need to consider both durability of the bioprosthetic aortic valves and the possibilities for re-valving when the valve eventually fails.