AVR for high-risk patients, data for PPM was not reported. However, postoperative aortic valve areas and gradients were slightly better for TAVI than AVR: 1.59±0.48 vs. 1.44±0.4 cm2 (P=.002); 10.2 mm & 11.5 mm (P=0.008). At 1 year, relief of symptoms was similar in both groups.

The reported valve areas suggest that smaller prostheses were implanted in both groups. In addition to having no capability for aortic leaflet resection, TAVI has no capability for aortic root enlargement. Dacron patch graft angioplasty is commonly employed during AVR to enlarge small aortic roots at least one size to allow implantation of a larger conventional prosthesis. At present, only selleck screening library biological prosthetic valves are available for TAVI. Mechanical Inhibitors,research,lifescience,medical valves are still considered the optimal choice in younger patients.2 While some patients who have experienced biological valve failure may have undergone “resleeving” selleck chemicals procedures during a second TAVI procedure, it is currently Inhibitors,research,lifescience,medical not established as a standard therapy.12, 13 Concurrent CAB was performed in 27% to 34% of our patients. Although angioplasty would be an option in some cases, many Inhibitors,research,lifescience,medical had diffusely calcified multivessel disease. Finally, TAVI requires adequate peripheral arterial access. Peripheral vascular disease was noted to be present in 43% of the PARTNER trial patients.4, 5 Future Evolution of

TAVI Studies using new prostheses are attempting to overcome issues with vascular access by reducing the size of the unit that has to be introduced into the femoral artery. Thinner, steerable catheters designed to minimize contact with the aortic wall are also in development. TAVI systems that are easier to align and deploy, and can be redeployed if needed, will soon be available. However, the current family of TAVI devices Inhibitors,research,lifescience,medical is still

based on the concept of fixing Inhibitors,research,lifescience,medical the prosthesis in position by forceful dilatation and compression of the stenotic calcified aortic valve leaflet tissue. The material that must be present for this to be achieved is only available in the presence of calcific degeneration of the aortic valve, as seen in aortic stenosis; this is because the aortic valve has no annulus. AVR by surgical implantation involves resecting the diseased aortic leaflets, leaving a narrow rim Anacetrapib at the base of the leaflet that consists of the junction of the leaflet with the aortic wall, aorto-mitral continuity, membranous septum, and the shoulder of the left ventricular myocardium. The left ventricular outflow tract begins at the lower margin of the anterior mitral leaflet and extends to where the aortic leaflets attach to the aortic wall and left ventricle; the posterior one-third to one-half consists of the aorto-mitral continuity and the anterior mitral leaflet. Thus, in the absence of the ring of calcified tissue seen with calcific aortic stenosis in the elderly, some other approach for prosthetic fixation will need to be developed.