Conventional Aortic Valve Replacement: Standard Therapy in the 1990s and the Development of Minimally Invasive Approaches

Aortic valve replacement (AVR) was established in the 1960s as a routine therapy to treat patients with relevant aortic valve dysfunction. During the consecutive years, different generations of mechanical and biological valves were developed. In the 1990s, these developments led to several standardized stented prostheses which were routinely available ([Fig. 1]). In parallel, AVR has developed as a routine procedure with low morbidity and mortality in experienced centers. Similar to today's practice aortic stenosis was the underlying pathology in the vast majority of patients. Conventional bileaflet mechanical valves or stented bioprostheses were routinely used to replace severely calcified native valve cusps. AVR was usually performed using full sternotomy access and cardiopulmonary bypass support. While excellent patient safety and good patient outcomes were reached with these standardized procedures, there seemed to be little potential for further innovations and improvements in that field.

Fig. 1 Mechanical valves (left upper two), conventional stented bioprostheses (left lower two), and stentless Toronto porcine bioprosthesis (right).

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