From minimally invasive to percutaneous aortic valve replacement

  • Lenard Conradi
  • H. Treede
  • H. Reichenspurner


The incidence of valvular heart disease (VHD) has steadily increased over the past few decades in western communities and is expected to continuously do so in the face of an aging population. The majority of valvular lesions in Europe and North America are of an acquired origin and occur in the fifth to eighth decade of life. Calcified aortic valve stenosis (AS) and degenerative mitral valve regurgitation (MR) are the two most frequent forms of acquired VHD and account for over 70% of cases in Europe [1]. In Germany, about 98 000 cardiac surgical procedures are performed annually. In 2008, 33 400 cases included valve procedures with 12 300 patients receiving isolated aortic valve replacement (AVR). Mortality rates have been stable around 3 to 4% for single AVR in spite of the ever increasing average patient age and associated comorbidities. The choice of prosthesis in the aortic position has shifted with the majority of diseased valves being replaced by a bioprosthesis today [2]. In contrast to coronary surgery where the decline in the number of operations has been accompanied by a rising procedural volume of percutaneous coronary interventions (PCI) since the late 1990s, valve surgery is still expanding.


Aortic Valve Aortic Valve Replacement Transcatheter Aortic Valve Implantation Valvular Heart Disease Percutaneous Coronary Intervention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24:1231–1243CrossRefPubMedGoogle Scholar
  2. 2.
    Leistungsstatistik DGTHG 2007Google Scholar
  3. 3.
    Bonow RO, Carabello BA, Chatterjee K et al (2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed for the Society of Cardiovascular Anesthesiologist, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52:c1–142CrossRefGoogle Scholar
  4. 4.
    Rosenhek R, Binder T, Porenta G et al (2000) Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 343:611CrossRefPubMedGoogle Scholar
  5. 5.
    Monin JL, Quere JP, Monchi M, Petit H, Baleynaud S, Chauvel C, Pop C, Ohlmann P, Lelguen C, Dehant P, Tribouilloy C, Gueret P (2003) Low-gradient aortic stenosis, operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation 108:319–324CrossRefPubMedGoogle Scholar
  6. 6.
    Cosgrove DM 3rd, Sabik JF (1996) Minimally invasive approach for aortic valve operations. Ann Thorac Surg 62:596CrossRefPubMedGoogle Scholar
  7. 7.
    Cohn LH, Adams DH, Couper GS et al (1997) Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 226:421CrossRefPubMedGoogle Scholar
  8. 8.
    Gundry SR, Shattuck OH, Razzouk AJ, del Rio MJ, Sardari FF, Bailey LL (1998) Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 65:1100–1004CrossRefPubMedGoogle Scholar
  9. 9.
    Detter C, Deuse T, Boehm DH, Reichenspurner H, Reichart B (2002) Midterm results and quality of life after minimally invasive vs. conventional aortic valve replacement. J Thorac Cardiovasc Surg 50:337–341CrossRefGoogle Scholar
  10. 10.
    Reiter B, Beinke A, Wipper SH, Schönebeck J, Sprathoff N, Treede H, Boehm DH, Detter C, Reichenspurner H (2007) Minimal invasive aortic valve surgery: The development of a single center from the beginning until now. Thorac Cardiovasc Surg 55:S1Google Scholar
  11. 11.
    Bonacchi M, Prifti E, Giunti G, Frati G, Sani G (2002) Does Ministernotomy improve postoperative out come in aortic valve operations? A prospective randomized study. Ann Thorac Surg 73:460–466CrossRefPubMedGoogle Scholar
  12. 12.
    Dogan S, Dzemali O, Wimmer-Greinecker G et al (2003) Minimally invasive versus conventional aortic valve replacement: a prospective randomized trial. J Heart Valve Dis 12:76–80PubMedGoogle Scholar
  13. 13.
    Moustafa MA, Abdelsamad AA, Zakaria G, Omarah MM (2007) Minimal vs. median sternotomy for aortic valve replacement. Asian Cardiovasc Thorac Ann 15: 472–475PubMedGoogle Scholar
  14. 14.
    Rosengart TK, Feldman T, Borger MA, Vassiliades TA, Gillinov AM, Hoercher KJ, Vahanian A, Bonow RO, O’Neill W (2008) Percutaneous and minimally invasive valve procedures. A scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 117:1750–1767CrossRefPubMedGoogle Scholar
  15. 15.
    Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-base study. Lancet 368: 1005–1011CrossRefPubMedGoogle Scholar
  16. 16.
    Lund O, Nielsen TT, Emmertsen K, Flo C, Rasmussen B, Jensen FT, Pilegaard HK, Kristensen LH, Hansen OK (1996) Mortality and worsening of prognostic profile during waiting time for valve replacement in aortic stenosis. Thorac Cardiovasc Surg 44:289–295CrossRefPubMedGoogle Scholar
  17. 17.
    Andersen HR, Knudsen LL, Hasenkam JM (1992) Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur Heart J 13:704–708PubMedGoogle Scholar
  18. 18.
    Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB (2002) Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis: First Human Case Description. Circulation 106:3006–3008CrossRefPubMedGoogle Scholar
  19. 19.
    Webb JG, Chandavimol M, Thompson CP, Ricci DR, Carere RG, Munt BI, Buller CE, Pasupati S, Lichtenstein S (2006) Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 113:842–850CrossRefPubMedGoogle Scholar
  20. 20.
    Walther T, Simon P, Dewey T, Wimmer-Greinecker G, Volkmar F, Kasimir M et al (2007) Transapical minimally invasive aortic valve implantation. Circulation 116:I240–I245CrossRefPubMedGoogle Scholar
  21. 21.
    Schofer J, Schlüter M, Treede H, Franzen O, Tübler T, Pascotta A, Low RI, Bolling SF, Meinertz T, Reichenspurner H (2008) Retrograde transarterial implantation of a nonmetallic aortic valve prosthesis in high surgical-risk patients with severe aortic stenosis: A first-in-man feasibility and safety study. Circ Cardiovasc Intervent 1:126–133CrossRefGoogle Scholar
  22. 22.
    Walther T, Chu MWA, Mohr FW (2008) Transcatheter aortic valve implantation: time to expand?. Curr Opin Cardiol 23:111–116CrossRefPubMedGoogle Scholar
  23. 23.
    Cribier A, Eltchaninoff H, Tron C (2006) Percutaneous implantation of aortic valve prosthesis in patients with calcific aortic stenosis: technical advances, clinical results and future strategies. J Invasive Cardiol 19:88–96Google Scholar
  24. 24.
    Collart F, Feier H, Kerbaul F, Mouly-Bandini A, Riberi A, Mesana TG, Metras D (2005) Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg 27:276–280CrossRefPubMedGoogle Scholar
  25. 25.
    Mack M (2008) Fool me once, shame on me. Fool me twice, shame on you. A perspective on the emerging world of percutaneous heart valve therapy. J Thorac Cardiovasc Surg 136:816–819CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Lenard Conradi
    • 1
  • H. Treede
  • H. Reichenspurner
  1. 1.Klinik und Poliklinik für Herz- und GefäßchirurgieUniversitäres HerzzentrumHamburgGermany

Personalised recommendations