Transfemoral TAVR: Balloon-expandable valves

Since the first percutaneous transcatheter heart valve (THV) implantation in 2002, balloon-expandable THV and delivery catheter technology as well as procedural aspects of transcatheter aortic valve replacement (TAVR) have rapidly evolved. Recently large multicenter trials and registries have confirmed the safety and efficacy of TAVR using balloon-expandable valves in patients with severe symptomatic aortic stenosis (AS) deemed at high or extreme risk for surgical aortic valve replacement (SAVR). Newer-generation balloon-expandable THVs have demonstrated excellent hemodynamic results, reductions in paravalvular regurgitation (PVR), and improvements in clinical outcomes, namely, lower rates of major vascular complications given lower-profile delivery systems. Valve durability has been demonstrated up to 5 years in patients receiving the first-generation SAPIEN THV. With increasing operator experience and further refinements in balloon-expandable THV technology, clinical trials are currently testing the efficacy of TAVR (compared to surgical aortic valve replacement (SAVR)) in lower-risk patients with severe symptomatic AS.