Percutaneous aortic valve implantation: present and future. Controlled clinical application before the results of randomised trials.

I n recent memory it was not uncommon to encounter elderly patients, with severe aortic valve stenosis and coexistent pathologies that rendered them inoperable because of unacceptably high risk, to whom we were unable to offer any other effective treatment. They were perhaps the second most common group of patients in this age group, after those with end-stage ischaemic heart failure, where the cardiologist felt completely unable to intervene effectively. During the last two years we have all been watching how the clinical application of percutaneous aortic valve implantation has been changing the treatment of these patients dramatically. Thus, with an acceptable single-figure interventional mortality, an untreatable condition with a very bad prognosis and a poor quality of life has been transformed into a treatable condition that potentially no longer affects expected survival. Surgical aortic valve replacement dates back to the 1960s and has been shown to improve the symptoms and prognosis of patients with calcific stenosis of the aortic valve, regardless of age. Valvuloplasty was proposed and adopted towards the end of the 1980s and the start of the 1990s as an alternative, less invasive treatment of aortic valve stenosis. Its use, however, was not limited exclusively to patients with high surgical risk, and it soon became clear that this Percutaneous Aortic Valve Implantation: Present and Future. Controlled Clinical Application Before the Results of Randomised Trials