Aortic valve: Conventional valve replacement and transcatheter valve implantation

The natural history of untreated severe aortic valve stenosis (AS), with an average survival of 3 years after the onset of angina or syncope and only 1½ years after onset of heart failure, strongly suggests early surgical therapy which represents the only curative option. Since the first pioneering work in the early 1960s, conventional aortic valve replacement (AVR) has become a routine procedure performed more than 200,000 times annually worldwide. The surgical technique of AVR has evolved to a highly standardized procedure resulting in excellent outcome and patient safety. Transcatheter techniques have emerged in the last decade allowing for valve implantation with avoidance of important complications of major surgery particularly in high-risk patients. However, potential drawbacks and procedure-related complications remain important. The techniques and technologies continue to emerge and improve. Conventional surgery, valve substitutes, and transcatheter technologies are discussed in this chapter.