Antithrombotic therapy after transcatheter aortic valve implantation: a new piece of the still unresolved puzzle

The 2017 marks the 40th anniversary of percutaneous coronary intervention (PCI), but also the 15th anniversary for transcatheter aortic valve implantation (TAVI) (1). For more than 50 years, surgical aortic valve replacement (SAVR) has been the standard of care for patients with severe symptomatic aortic stenosis, improving outcomes and prolonging the lives of these patients. In 1990s the transcatheter delivery of a bioprosthetic aortic valve was conceptualized and largely tested in animals. The first human implantation of a percutaneous implantable prosthetic heart valve composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was performed in Rouen on 16 April 2002 in a 57-year-old desperately ill man in cardiogenic shock, with critical aortic stenosis, subacute leg ischemia deemed inoperable due to multiple comorbidities (valve replacement had been declined for this patient, and balloon valvuloplasty had been performed with nonsustained results) (2)