The challenging pathway to TAVI: in memory of Alain Cribier

Abstract

In 1998, in response to a comment on the limited durability of an aortic valvuloplasty performed during the last Madrid Interventional Cardiology (MIC) course, Alain Cribier insightfully stated: “We’ll mount a stent on the valvuloplasty balloon, attach the leaflets, and problem solved.” Four years and countless hours of work later, both at his hospital in Rouen, France, and at the animal experimentation center in Lyon, France, the recently deceased Alain Cribier (1945-2024) achieved a groundbreaking milestone.1 On April 16, 2002, he performed the world’s first surgery-free transcatheter aortic valve implantation (TAVI), prolonging the patient’s life and revolutionizing heart valve surgery. This innovation dramatically improved the quality of life of a high percentage of patients with severe aortic stenosis who were ineligible for conventional heart surgery. Since then, more than a million patients have benefited from his technological innovation. After this pivotal first case of TAVI,1 isolated procedures were performed in selected patients in the following years, with few technical variations, and all via antegrade access. While interventional cardiologists were enthusiastic and had high expectations, critics predicted apocalyptic disasters due to alleged complications, such as vascular complications, valve instability and migration, coronary occlusion, strokes, annular and aortic rupture, paravalvular regurgitation, and concerns...