The present case demonstrated that a bioprosthetic valve could be implanted percutaneously within a stenotic native aortic valve. The valve orifice and hemodynamics were similar to those achieved with surgical prosthesis and far superior to those achieved with balloon valvuloplasty alone (13
However, clinical experience remains limited. In vitro valve durability has been repeatedly documented at 200 million cardiac cycles, which correlates to more than five years of life (10
). The potential for complications with this new procedure is not yet well understood, but risks include arterial access site injury, valve malposition or embolization, vascular or cardiac perforation, arrhythmias, stroke, myocardial infarction, infection and death. Mild paravalvular leaks are relatively common, and more severe leaks can occur.
The relatively unproven nature and inherent risks of this new therapy argue for a formal team approach to patient selection and outcome analysis. Surgical consultation and involvement is mandatory to assess surgical alternatives, vascular access issues and surgical options should complications occur. Nursing input has also facilitated periprocedural care planning for these patients. A steep learning curve, risks and risk for oversight associated with an immature technology argue for a limited dissemination to a small number of specialized centres.
It is likely that progressive development of technology, techniques and better understanding of appropriate criteria for patient selection will expand the indications for percutaneous valve procedures. Currently, this procedure is an option for symptomatic patients who are not appropriate candidates for surgical valve replacement.