The Transcatheter Valve Revolution

D ow nloaded from DOI: 10.1161/CIRCULATIONAHA.112.123513 2 The last 2 years have seen a torrent of information regarding transcatheter aortic valve replacement (TAVR), and it is no exaggeration to say that this compelling technology has revolutionized our approach to treatment of valvular aortic stenosis. High risk and inoperable patients heretofore relegated to minimally effective medical therapies have been offered a return to activity and in some cases, a longer life1, 2. Yet, not all the news is good. While the rate of vascular complications has subsided with lower profile tools and increased experience, they remain vexingly high. Similarly, stroke rates hover around 5 % with some data suggesting they are higher than the risk associated with conventional surgery3. Earlier this year, data emerged that even mild paravalvar leak (a common occurrence post-implantation) was associated with considerably worse outcome4. Finally, th