Percutaneous aortic valve interventions in heart failure patients

The onset of symptoms of heart failure is a landmark in the natural history of aortic stenosis, and is associated with a dramatic reduction in survival. Aortic valve replacement markedly increases life-expectancy in such patients. However, the presence of heart failure and/or left ventricular dysfunction are strong predictors of poor acute and late mortality after cardiac surgery and the most frequent conditions leading to deny surgical aortic valve replacement in elderly patients. The last decade has witnessed the development of transcatheter aortic valve implantation (TAVI) and, consequently, the resurgence of percutaneous balloon aortic valvuloplasty (PBAV) and, both, are currently routine therapy for high-risk patients. These minimally invasive procedures are appealing therapeutic options for the subset of patients with heart failure and or/left ventricular systolic dysfunction. The available evidence on the results of PBAV and TAVI therapies in this setting is discussed and a management strategy is proposed.