Volume 41 - Issue 6

This article summarizes the author's experience with aortic valve reimplantation, focusing on technical errors that may adversely affect outcome. This is a complex surgical procedure that requires detailed knowledge of the functional anatomy of the aortic valve and how disease affects its components. The procedure was developed to correct abnormal components of the aortic root in patients with aortic root aneurysms, both sporadic and associated with genetic syndromes, with the aim of restoring the native aortic valve anatomy and function. When applied to properly selected patients and performed correctly, the very long-term outcomes are gratifying for both the patient and the surgeon.

Transcatheter aortic valve implantation (TAVI) has profoundly changed the management of severe aortic stenosis (AS), evolving from a treatment reserved for inoperable and high-risk patients to an established therapeutic option across a wide surgical risk spectrum. Although the expansion of TAVI indications has been largely supported by randomized clinical trials conducted in high-income countries, real-world experience and technological contributions from distinct healthcare systems are increasingly relevant. Brazil has played a significant role in the early adoption, structured implementation, and clinical evaluation of TAVI in Latin America. Since the first procedures performed in 2008, Brazilian centers have developed Heart Team models, contributed to national and regional registries, and generated real-world evidence demonstrating procedural safety and effectiveness comparable to international benchmarks, despite the presence of resource limitations and a higher prevalence of complex clinical and anatomical scenarios. The incorporation of TAVI into the Brazilian public health system in 2022 marked a major milestone in expanding access to minimally invasive therapy for patients with severe AS. In parallel, Brazilian scientific societies have adapted international guideline recommendations to local practice, supporting evidence-based patient selection across different surgical risk categories. Notably, Brazil has also emerged as a developer of locally engineered transcatheter valve technologies, highlighting its transition from a technology consumer to an active contributor in the field of structural heart disease. This review summarizes the historical evolution, national experience, clinical outcomes, guideline integration, technological innovation, and health economic considerations of TAVI in Brazil.

The treatment of aortic diseases has undergone profound transformation over the last decades, with the progressive incorporation of endovascular techniques either replacing or complementing conventional open surgical repair. The development of aortic stents represents one of the most significant milestones in this transition. This article reviews the historical, experimental, and clinical evolution of aortic stents, with emphasis on pioneering Brazilian contributions, including the experimental phase in animal models, the first clinical applications in aortic dissection, and the role of the national industry in the development and dissemination of these technologies. The impact of these innovations on contemporary cardiovascular surgical practice and future perspectives are also discussed.