Aortic valve disease is a condition that is currently on the increase. The progressive population ageing due to increased life expectancy, particularly in developed countries, has established this disease as the most prevalent of all valve diseases. In particular, degenerative or calcified aortic stenosis is the most common valve disease in patients older than 75 years. Until a few years ago, valve replacement surgery was the only technique to demonstrably reduce mortality compared with medical treatment, when patients started to have symptoms. However, this paradigm has been changed by the emergence of the percutaneous treatment of aortic stenosis. Initial studies have demonstrated the benefits of this technique in reducing mortality in patients with contraindications for conventional surgery or in patients with high surgical risk. Thanks to a large investment in research and development, the technique and the procedure have been optimized, thus improving clinical outcomes. In the not too distant future, this less invasive technique will likely replace conventional valve replacement surgery.
Therefore, the arrival of this manual is more than welcome: it is relevant, up to date, and needed by the general medical community. This book will be of great use for cardiologists, interventional cardiologists, resident physicians in cardiology, imaging specialists, and clinical fellows undergoing training in this technique. It is edited by Dr Diego López Otero and Dr Pablo Avanzas Fernández and has the explicit support of the Department of Catheterization and Interventional Cardiology of the Spanish Society of Cardiology. In addition, the president of the Spanish Society of Cardiology wrote the prologue of the book.
The work features the collaboration of 128 authors and is divided into 24 chapters, with a total of 356 pages. The chapters aim to follow a logical order, starting with the epidemiology of the disease, a literature review, a description of the requirements for starting a percutaneous treatment program, the different clinical, diagnostic and technical aspects of the procedure, and finally, a description of complications resulting from the technique. Five chapters are dedicated to complications (1 for each of the most common types of complication).
The format of the manual makes a good impression: the hardback cover and the quality of the figures and tables is notable. There is room for improvement in the text density in many of the chapters, with a medium size, single-spaced font, which does not particularly invite reading. Also, it would be desirable to change the order of some of the chapters. Specifically, chapter 11 is dedicated to measuring the annulus using imaging techniques, and the last chapter (chapter 24), again discusses the usefulness of imaging techniques prior to implantation. In my opinion, both of these chapters should be presented together and in the middle of the book, and overlapping of concepts between the 2 chapters should be avoided. Something similar happens with chapters 7 and 14, which deal with similar aspects of the same subject (specifically, high risk patients in chapter 7 and off-label indications in chapter 14). Finally, the manual dedicates a chapter to the description of the technique using the CoreValve system (chapter 12) and another to the Edwards SAPIEN system (chapter 13). However, there are no chapters dedicated to the other systems that are currently approved for clinical use. Overall, these limitations do not tarnish the merits of the work and the coordination efforts of Dr López and Dr Avanzas, who have allowed such a complete work to be produced.