Volume 68, Issue 2 Louisville Medicine | Page 22

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