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(Circulation. 2006;114:533-535.)
© 2006 American Heart Association, Inc.

Editorial

The Evolving Treatment of Aortic Stenosis

Do New Procedures Provide New Treatment Options for the Highest-Risk Patients?

John D. Carroll, MD

From the Division of Cardiology, University of Colorado Health Sciences Center, Denver and Aurora, Colo.

Correspondence to John D. Carroll, MD, Professor of Medicine, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B132, Denver, CO 80262. E-mail john.carroll@uchsc.edu

Key Words: Editorials • aging • aorta • stenosis • surgery • valves

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The percutaneous treatment of valvular heart disease is rapidly progressing through clinical trials. For one valvular lesion, critical aortic stenosis, recent advances in technology and percutaneous techniques may potentially change the way in which we manage this disease in the most frail and elderly patients. Some of these new techniques blur the distinction between surgical and nonsurgical treatments. In this issue of Circulation, Lichtenstein and colleagues report the first series of patients to have an aortic valve implanted via a thoracotomy to expose the left ventricular apex, for subsequent sheath insertion, over-the-wire delivery system advancement, and image-guided implantation of a stent mounted equine crimped on a delivery balloon.¹ This article is seminal in defining 2 major emerging issues: valvular heart disease treatments that are hybrids of surgical and catheter-based techniques and the challenges inherent in determining what treatment modalities are best in the growing problem of aortic stenosis in mature, ie, elderly, adults. This report adds to the recently published report from the St. Paul’s Hospital group in Vancouver using the retrograde percutaneous aortic valve (PAV) implantation technique.²

Article p 591

Which patients will be appropriate for these new approaches to the treatment of aortic stenosis in the mature adult population? Timely assessment of the efficacy and safety of these techniques will be critical for patients, care providers, regulatory agencies, and insurers to evaluate for patient-specific decision making and healthcare policy.

	The Critical Data Needed in Apical and Percutaneous Aortic Valve Implantation

 

• Safety. The present small study had a 1-month mortality of 14%. One additional death would have made . . . [Full Text of this Article]

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