Ann. N.Y. Acad. Sci. ISSN 0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Issue: Aging, Cancer, and Age-Related Diseases The marvel of percutaneous cardiovascular devices in the elderly Robert Guidoin, 1 Yvan Douville, 1 Marie-Annick Clavel, 2 Ze Zhang, 1 Mark Nutley, 1 Philippe Pˆıbarot, 2 and Guy Dionne 1 1 Department of Surgery, Laval University and Quebec Biomaterials Institute, CHUQ, Quebec, Canada. 2 Department of Medicine, Laval University and Quebec Heart Institute, Laval Hospital, Quebec, Canada Address for correspondence: Dr. R. Guidoin, Department of Surgery, Faculty of Medicine, Vandry Building, Laval University Quebec, Quebec G1K 7P4, Canada. robertguidoin@hotmail.com Thanks to minimally invasive procedures, frail and elderly patients can also benefit from innovative technologies. More than 14 million implanted pacemakers deliver impulses to the heart muscle to regulate the heart rate (treating bradycardias and blocks). The first human implantation of defibrillators was performed in early 2000. The defib- rillator detects cardiac arrhythmias and corrects them by delivering electric shocks. The ongoing development of minimally invasive technologies has also broadened the scope of treatment for elderly patients with vascular stenosis and aneurysmal disease as well as other complex vascular pathologies. The nonsurgical cardiac valve replacement represents one of the most recent and exciting developments, demonstrating the feasibility of replacing a heart valve by way of placement through an intra-arterial or trans-ventricular sheath. Percutaneous devices are particularly well suited for the elderly as the surgical risks of minimally invasive surgery are considerably less as compared to open surgery, leading to a shorter hospital stay, a faster recovery, and improved quality of life. Keywords: pacemakers; defibrillators; stents; stent-grafts; percutaneous heart valve; elderly; high risk patient Introduction Blood supply to the whole body cannot be im- paired unless dramatic consequences follow, includ- ing lethal issues. Peter Schneider’s statement: “I am a believer in good blood supply” might be every car- diovascular physician’s motto. 1 Globally an aging population requires increasing healthcare services. Minimally invasive procedures and implants allow many patients to now be offered a therapeutic op- tion that until recently did not exist, thus permitting their survival and/or enhanced quality of life. A myr- iad of implants have been developed which can ame- liorate problems in cardiovascular surgery (valves, stents, stent-grafts, and vascular prostheses), physi- ologic or endocrine support (blood oxygenators, ar- tificial kidneys, artificial livers, artificial pancreas), structural or functional support (orthopaedic im- plants, ophthalmic implants) and transmission of electrical or sensory signals (pacemakers and defib- rillators, cochlear implants, and visual implants). Elderly and frail patients who have certain types of dysarrhythmias can now benefit from signal trans- mitting devices, which guarantee the mechanical function of the heart. More than 15 million pace- makers, which deliver impulses to the heart muscle to regulate the heart rate (bradycardia and block), have been implanted. This technology has evolved rapidly since the first human implantation by Ake Senning in 1958. 2 The fist human implantation of defibrillators capable of delivering higher en- ergy electrical pulses to treat ventricular fibrillation and tachycardia were performed at the turn of the century. 3 Other pathologies which are now being treated in this minimally invasive manner include arterial stenosis and aneurysms. Dotter, Gr¨ untzig, and Pal- maz pioneered angioplasty and stenting of arteries to nonsurgically dilate stenotic or calcified vessels since the early 1960s. 4–6 Puel was the first to de- ploy coronary artery stents in humans in 1993. 7 These devices, as well as the newer drug-eluting doi: 10.1111/j.1749-6632.2010.05517.x 188 Ann. N.Y. Acad. Sci. 1197 (2010) 188–199 c  2010 New York Academy of Sciences.