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Aortic stenosis prevalence and balloon aortic valvuloplasty publish

The transformation in the field of interventional cardiology is unprecedented. Since the late 1970's, rapid changes have taken place, and today, interventional cardiology encompasses an ever-growing list of diagnostic and therapeutic percutaneous procedures performed in the cathlab. The field was initially driven by the treatment of the vasculature system, but has expanded over the last 15 years to structural heart disease.

Prevalence of aortic stenosis — an unmet clinical need

Degenerative aortic stenosis has been a longstanding challenge to cardiologists dealing with an increasingly aging population. Many of these patients are deemed too sick for surgery. This led to a less invasive treatment option that could be adapted to patients who had no surgical alternatives, that of balloon aortic valvuloplasty (BAV).

senile aortic stenosis development

Development of senile aortic stenosis

Business card: Prof. A. Cribier

Although first introduced for children with congenital stenosis (Lababidi), the first BAV performed on an adult patient was in Rouen in 1985 by Prof. Cribier and Prof. Brice Letac. The first procedure was on a 72-year-old patient who was denied surgery because of her age and her concomitant coronary artery disease. The patient remained asymptomatic for 2 years and the treatment was initially considered an exciting step forward.

TAVI seminar: balloon aortic valvuloplasty 1999

Rouen, 1st International Course with live BAV demonstrations

Bernhard Meier was also an early inventor and adopter of balloon aortic valvuloplasty, working with Schneider Medintag on the Trefoil balloon. The tri-folds enabled flow to not be completely obstructed by the balloon and enabled higher pressures.

Nonetheless, unlike with mitral or congenital aortic stenosis, there were no fused commissures which could be split. After thousands of patients were treated, the procedure was mostly abandoned as most patients showed 75%-80% restenosis rates at 1 year and it was reduced to a palliative therapy for a subset of patients.

Percutaneous valve replacement became Alain Cribier’s dream for treating Aortic stenosis (AS). It was the holy grail. 

This was achieved in 2002 and has evolved into the most important therapeutic technique in interventional cardiology since PCI.