GETTING TO THE HEART OF MEDICINE
THE HISTORY OF
TRANSCATHETER AORTIC
VALVE REPLACEMENT
(TAVR)
AUTHOR Brian W. Kaebnick, MD
The history of transcatheter aortic
valve replacement (TAVR) development
follows the work of pioneers
in the field of interventional
cardiology, to address an unmet
need for those with aortic stenosis.
Aortic stenosis is a common disease
with a prevalence of 12.4% in
the population and approximately 3.4% will have severe stenosis. 1
Older individuals make up a majority of this population as degenerative
non-rheumatic aortic stenosis increases exponentially with
age with a 9.8% prevalence in individuals 80-89 years of age. 2 Prior
to TAVR, the only method of addressing aortic stenosis was open
surgical replacement of the valve. Surgical aortic valve replacement
(SAVR) is a very effective procedure and significantly improves survival
and quality of life of those with aortic stenosis. Unfortunately,
SAVR did exclude a significant proportion of the population who
were not good surgical candidates. It has been estimated that prior
to TAVR, approximately a third of patients with severe symptomatic
aortic stenosis never received treatment. 3 It was this need that drove
the development of transcatheter-based valve therapies. Knowing
the history of its development provides key insights into current
practices and future therapies.
The interest in percutaneous approaches to valvular heart disease
is not a recent interest. The first percutaneous valve treatment
actually predates coronary interventions. Rubio-Alvares and Limon-Lason
performed the first percutaneous valve intervention
in 1952 at the Instituto de Cardiologia in Mexico using a ureteral
catheter and a guitar string to slice open a stenosed tricuspid valve. 4
Other early attempts included a parachute-like valve attached to a
catheter via the femoral artery temporarily to help manage aortic
insufficiency; however, this idea never made it past animal models
and was never used in humans. 5 Progress in catheter-based therapies
was stagnant until 1979 when Dr. Semb used a balloon-tipped
20 LOUISVILLE MEDICINE