"Alain Cribier has been a driving force for catheter-based therapies for valvular heart disease since the mid-1980s. He has brought us to where we are today, with continually evolving technology for aortic valve replacement," said Ted Feldman, M.D., FSCAI, director of the cardiac catheterization laboratory at Evanston Hospital, in Evanston, IL, and a professor of medicine at Northwestern University Medical School in Chicago. "Dr. Cribier has had a remarkable career."
Aortic stenosis most often afflicts the elderly. After years of wear and tear, the valve that serves as a portal between the left ventricle and the aorta becomes calcified, stiff, and narrowed, no longer permitting enough blood to flow from the heart to the rest of the body. Patients typically develop shortness of breath, heart failure, chest pain, and sometimes lightheadedness and fainting.
Surgery to replace the aortic valve is very effective, but it involves opening the chest and requires a lengthy recovery. At least one-third of elderly patients with aortic stenosis are too frail to withstand such major surgery.
With percutaneous aortic valve replacement, a balloon catheter with a stent-mounted valve crimped on its tip is threaded from the femoral artery in the groin into the aorta and across the aortic valve, in a direction opposite—or retrograde—to normal blood flow. The compressed valve is moved into position in the diseased aortic valve and a balloon at the end of the catheter is inflated. The expanded valve pushes aside the diseased leaflets of the patient’s own aortic valve and becomes anchored in the valve opening.
The valve can also be implanted through a small incision in the chest and a puncture in the bottom of the left ventricle. This technique is particularly useful in patients with widespread build-up of atherosclerotic plaque, which may make it impossible to pass a catheter through the arteries of the legs and abdomen.
Dr. Cribier, who is chief of cardiology at University Hospital, in Rouen, France, performed the first human percutaneous aortic valve implantation in 2002. Since then, the Cribier-Edwards valve has since been tested in North America and Europe. A multicenter phase 2 randomized controlled trial is expected to begin soon in the United States. Another replacement aortic valve, the self-expanding CoreValve, is also undergoing clinical testing.
"The opportunity for patients to be treated in clinical trials will expand rapidly as the number of these devices grows," Dr. Feldman said. "Catheter-based aortic valve replacement is set to take off."
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About SCAI
Headquartered in Washington, DC, the Society for Cardiovascular Angiography and Interventions is a 3,700-member professional organization representing invasive and interventional cardiologists in 70 nations. SCAI’s mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI’s annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty. |
