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J Thorac Cardiovasc Surg 2007;133:294-298
© 2007 The American Association for Thoracic Surgery

Editorial

Percutaneous aortic valve replacement: Which patients are suitable for it? A quest for a controlled use

Department of Cardiac, Thoracic, and Vascular Sciences, Padua University Medical School, Division of Cardiac Surgery, Padova, Italy.

Received for publication July 25, 2006; accepted for publication August 8, 2006.

^_* Address for reprints: Gino Gerosa, MD, Division of Cardiac Surgery, Department of Cardiac, Thoracic, and Vascular Sciences, Padua University Medical School, Via Giustiniani 2, 35100 Padova, Italy. (Email: gino.gerosa@unipd.it).

The first 300 words of the full text of this article appear below.

The internal thoracic artery–to–left descending coronary artery bypass graft (CABG) is recognized as the gold standard therapy for coronary artery disease. Nevertheless, percutaneous revascularization is currently adopted as the first-line approach, not only in the treatment of multivessel disease but even in the presence of left main stenosis and in patients with diabetes. Although no major randomized trials justify this policy, still it has been currently adopted.¹ Many reasons might explain the widespread embracement of endovascular techniques over surgery. In one word: simplification. The patient does not need to be sedated or intubated. The duration of the procedure is relatively short, and the results can be ex tempore visualized, allowing a possible adjustment. A very short hospitalization is required for recovery, and the patient’s stress is minimized. Finally, the procedures are easily repeatable, in contrast to the widely known risks of a resternotomy.

Just because of their simplified character, a wide number of interventional procedures are performed every day compared with cardiac operations, allowing the catheter technology to evolve rapidly: new techniques are launched on the market with an impressive speed and are applied in the catheterization laboratories with a quick turnover. By contrast, apart from spare attempts (ministernotomy, port-access technique, robotics), cardiac surgery techniques remain substantially unchanged since their introduction.

Valve surgery has long represented a stronghold for the cardiac surgeon, but things might change. In fact, although the research on the ideal valve substitute is still ongoing, endovascular techniques have recently been proposed as alternative therapies for both mitral and aortic disease. The attempt to renew valve surgery with the introduction of robotics for mitral valve surgery has actually complicated it. In fact, even if robotic surgery can minimize patient trauma and promote a faster recovery, it is associated with higher use of resources, in both economic and . . . [Full Text of this Article]

This article has been cited by other articles:

				R. Quaden, T. Attmann, M. Schunke, D. Theisen-Kunde, J. Cremer, and G. Lutter Percutaneous aortic valve replacement: Endovascular resection of human aortic valves in situ. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1081 - 1086. [Abstract] [Full Text] [PDF]