Of the techniques used to date, the retrograde approach seems most amenable to widespread acceptance, given its inherent advantage of being faster and easier. 11,21,30 Limitations with the retrograde approach seen in earlier trials—challenges and complications associated with large-bore arterial vascular access, difficulty traversing the aortic arch with bulky devices, and the inability to cross the stenotic aortic valve to deploy the prosthesis even after balloon valvuloplasty 11,21,30—are correctable with refinements in the devices and in technique.
New types of prosthetic aortic valves entering early human studies are improving on current devices, for example, by using collapsible, inflatable valve frames for retrievability before final deployment.
Surgical aortic valve replacement remains the gold standard treatment for patients with symptomatic aortic stenosis. And while studies of percutaneous aortic valve replacement show great promise for this less-invasive treat-men, enthusiasm about percutaneous aortic valve replacement should be tempered by an awareness of persistent limitations of this approach, such as vascular and mechanical complications and operator inexperience, which still need attention.