Review paper Indication for percutaneous aortic valve implantation Ibrahim Akin*, Stephan Kische*, Tim C. Rehders, Christoph A. Nienaber, Mathias Rauchhaus, Hüseyin Ince, Henrik Schneider, Andreas Liebold Department of Medicine I, Divisions of Cardiology, Pulmonology and Intensive Care Unit at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany Submitted: 7 November 2009 Accepted: 24 January 2010 Arch Med Sci 2010; 6, 3: 296-302 DOI: 10.5114/aoms.2010.14247 Copyright © 2010 Termedia & Banach *Both authors contributed equally to this manuscript. A b s t r a c t The incidence of valvular aortic stenosis has increased over the past decades due to improved life expectancy. Surgical aortic valve replacement is currently the only treatment option for severe symptomatic aortic stenosis that has been shown to improve survival. However, up to one third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to high comorbidities resulting in a higher operative mortality rate. In the past such patients could only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement with the goal of offering a therapeutic solution for patients who are unfit for surgical therapy. Currently there are two catheter-based treatment systems in clinical application (the Edwards SAPIEN aortic valve and the CoreValve ReValving System), utilizing either a balloon- expandable or a self-expanding stent platform, respectively. Key words: aortic stenosis, CoreValve, Edwards SAPIEN, EuroSCORE. Introduction Rising life expectancy results in an increase in degenerative and neoplastic diseases. Population-based observational studies have revealed that 1% to 2% of patients older than 65 years have moderate to severe aortic stenosis [1]. Surgical aortic valve replacement dates back to 1960 and is currently the only treatment option for severe aortic stenosis that has been shown to improve survival, regardless of age [2]. In the ideal candidate, surgical aortic valve replacement (AVR) has an estimated operative mortality of 4% [2]. Unfortunately, up to one third of patients with severe aortic stenosis (AS) are ineligible for corrective valve surgery, either because of advanced age or the presence of multiple comorbidities [3]. Current treatment options for those patients not offered surgery include medical treatment and percutaneous balloon aortic valvuloplasty, though neither has been shown to reduce mortality. Medically treated patients with symptomatic AS have a 1- and 5-year survival of 60% and 32%, respectively [4]. With the introduction of percutaneous aortic valve implantation in 2002 there seems to be an alternative for these patients. Corresponding author: Prof. Dr. Hüseyin Ince Department of Medicine I Divisions of Cardiology, Pulmonology and Intensive Care Unit University Hospital Rostock Rostock School of Medicine Ernst-Heydemann-Str. 6 18057 Rostock, Germany Phone: +49 (0)381 494 77 97 Fax: +49 (0)381 494 77 02 E-mail: hueseyin.ince@med. uni-rostock.de