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Patient Selection Crucial for Transcatheter AVR

Last Updated: May 14, 2009.

Transcatheter aortic valve replacement is becoming an increasingly used option for patients with symptomatic aortic stenosis who aren't good candidates for surgical valve replacement, according to an overview published in the May 19 issue of the Journal of the American College of Cardiology.

THURSDAY, May 14 (HealthDay News) -- Transcatheter aortic valve replacement (AVR) is becoming an increasingly used option for patients with symptomatic aortic stenosis who aren't good candidates for surgical valve replacement, according to an overview published in the May 19 issue of the Journal of the American College of Cardiology.

Alan Zajarias, M.D., of Washington University School of Medicine in St. Louis, and Alain G. Cribier, M.D., of the University of Rouen in France, discuss the evolution of transcatheter AVR during the past five years. An antegrade -- or transseptal -- approach to implantation gave way to the retrograde approach. More recently, a transapical approach has been developed, requiring a left lateral thoracotomy, with sheath insertion into the left ventricle.

Proper patient selection is crucial. Patients must have severe symptomatic aortic stenosis; formal contraindication to surgery or other factors that would excessively raise morbidity or mortality risk; and potential for functional improvement. A variety of factors influence the implantation route, including minimal lumen diameter and tortuosity of the aorta and the iliac and femoral arteries.

"Physicians must evaluate patients' needs and expectations knowing that in certain situations, comfort, symptom relief, and avoidance of morbidity are more important than increased longevity. Today, transcatheter AVR should remain limited to high-risk patients, and uncontrolled diffusion should be avoided. In the future, if the results continue to be favorable, increased indications for this technology may become available," the authors conclude.

Cribier disclosed a financial relationship with Edwards Lifescience.

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