Aortic Valve Replacement: Transcutaneous Versus Surgical the Race is on

Abstract

Aortic valve replacement (AVR) is the only treatment proven to reduce mortality in severe symptomatic aortic stenosis (AS). Though the conventional surgical AVR (SAVR) with prosthetic valve remains the gold standard, the procedure has significant morbidity and mortality especially in elderly patients with multiple co-morbidities and hence could not be offered to almost one third of patients with severe AS. This has led to numerous technological advances in the field of AVR since last decade. The evolution of transcutaneous aortic valve replacement (TAVR) has made AVR possible in patients with prohibitive surgical risk and significantly improved the mortality. Sutureless aortic valve replacement (SuAVR) using minimally invasive access has shown some advantage over TAVR especially in intermediate surgical group patients. The encouraging results of aortic valve repair using glutaraldehyde treated autologous pericardium (Ozaki technique) have given a hope for freedom from prosthetic valve disease, especially in relatively young individuals. In this review we discuss the latest advancement in field of AVR, which now looks like a race between interventional cardiologist and cardiothoracic surgeon; much like the coronary artery disease management.