Transcatheter aortic valve replacement

Approximately 250,000 procedures of TAVR have been performed worldwide in more than 1,000 centers, and about 15,000 patients were randomized in clinical trials showing that TAVR is a respected treatment option for symptomatic patients with severe AS [1]. The prognosis of these patients with symptomatic severe AS is poor without valve replacement, and the mortality rate is 50% at 2 years [2,3]. The aortic valve replacement (AVR) is the only treatment that has proved helpful in increasing survival rates of population and no clinical treatment has shown any efficacy in improving outcomes. Despite the 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for AVR as a class I indication for severe symptomatic AS [4], nearly one third of patients with severe symptomatic AS are not referred for surgical AVR.3 This is often because multiple comorbidities and frailty all result in poor prognosis and high mortality rates for surgical AVR [5]. Several new TAVR devices are now being used with modern features that address the limitations of the first-generation devices including paravalvular leak (i.e., lower profile, easier positioning, repositionability and retrievability). In this mini review, we will focus on the most important characteristics of TAVR procedure. Other purpose is to stimulate the development of new trial in the TARV field. Understanding the severe AS and the indications of valve replacement