Alain Cribier, MD, an interventional cardiology pioneer who implanted the first bioprosthetic transcatheter aortic valve, died Friday. He was 79. “Dr. Cribier’s passion and innovation to optimize treatment for aortic valve disease changed for generations the way we treat structural heart disease beyond TAVR [transcatheter aortic valve replacement],” said Ron Waksman, MD, the director of cardiovascular research and advanced education at MedStar Heart and Vascular Institute, Washington. “He should be remembered with every TAVR procedure that we are performing.” A man of ‘firsts’ Augusto D. “Gus” Pichard, MD, medical director and vice president of medical affairs at Abbott Structural Heart, counted Prof. Cribier as a close friend during his early career years and as he progressed until becoming director of the Cardiac Catheterization Laboratory at MedStar Washington Hospital Center. “He is an example of a physician who worked hard, remained humble and always went for quality,” Pichard said. Pichard, who is fluent in French, Spanish and English, was a longtime member of the French Society of Cardiology and helped found a meeting in France called “High Tech Cardio” more than 40 years ago. Prof. Cribier, who practiced at Charles Nicolle University Hospital in Rouen, France, was a regular at this meeting, and he and Pichard planned meetings and lectures and built a friendship. “He was always interested in developing things. He became a leader in Rotablator when Rotablator was just starting,” Pichard said of the rotational atherectomy system. “In Europe, he trained a lot of people through Rotablator. They would come to him to learn it, and he would travel to teach it.” Prof. Cribier was credited with a number of “firsts” in interventional cardiology. One of these was that he conducted the first balloon aortic valvuloplasty in 1985. Pichard said this led Prof. Cribier to travel the world. “The well-to-do, especially in America, would fly him over,” Pichard said. “So he flew to many cities in America to do this for wealthy people that wanted to have the procedure. And he would fly in for the day, do the procedure, and fly back.” Pichard added that he and Prof. Cribier hosted the Aortic Valvuloplasty Course at Washington Hospital Center in 1987. It featured seven live cases over 2 days. Pichard said all of the procedures were successful, and this was the first time aortic valvuloplasty was performed in the U.S. Prof. Cribier stopped doing this after he found that, while the procedure would make patients feel better initially but that most of them experienced restenosis. According to a profile of Prof. Cribier on PCRonline, this experience led him to pursue a new therapy that eventually became TAVR. First TAVR Stanton Rowe, the CEO of Nidus Biomedical and former corporate vice president of Edwards Lifesciences, recalled that he and others in Prof. Cribier’s circle at the time were “intrigued’ by his enthusiasm, which Rowe said was “contagious.” “His ideas were untested and unformed, but the concept of replacing surgery with a catheter-based technique was compelling for us, the early coronary stent pioneers,” Rowe wrote in a tribute that will soon be published in Cardiovascular Revascularization Medicine. “We struck a deal to do early feasibility work on the concept.” Pichard recalled that during these years, Prof. Cribier “had a lot of opposition in France because they thought this was crazy – his own hospital, his own colleagues at the medical meetings.” “I was the one – he gave me credit always – that supported him and said, ‘No, no, no. This is a terrific idea. You have to pursue it. You have to develop it. Keep doing it. Keep talking about it at the meetings,’” Pichard said. “And he was always very grateful. Every time he saw me, he would say, ‘Gus, if it wasn’t for your support, I would have abandoned this because I was getting so much pressure.’” In 1999, Prof. Cribier; Martin Leon, MD, now of Columbia University Irving Medical Center, New York; and the “two Stans,” Stan Rowe and Stan Rabinovich, founded Percutaneous Valve Technologies together, Rowe wrote. Prof. Cribier was part of the team that implanted the first TAVR valve in April 2002 at Charles Nicolle University Hospital, which he and his colleagues reported in a case report published in Circulation in December 2002. The procedure, performed in a 57-year-old man, was successful. Prof. Cribier and colleagues reported that immediately and at 48 hours after implantation, the patient’s valve function was “excellent” and remained satisfactory through 4-month follow-up, with no recurrence of heart failure. However, the patient died 17 weeks after the procedure due to noncardiac causes unrelated to the procedure. Rowe described this patient’s remarkable post-operation experience after the first ever transcatheter aortic valve replacement: he “sat up in bed that evening and drank champagne (a sip or two).” “After further device modifications, additional durability tests, and confirmatory clinical implantations, PHV [percutaneous heart valve] might become an important therapeutic alternative for the treatment of selected patients with nonsurgical aortic stenosis,” Prof. Cribier and colleagues concluded in what eventually proved to be prophetic, perhaps even an understatement, as TAVR is now an approved procedure for patients with aortic stenosis at all levels of surgical risk, from inoperable to low risk. In 2019, the year the U.S. Food and Drug Administration extended TAVR approval to low-surgical-risk patients, the volume of TAVR procedures exceeded all forms of surgical aortic valve replacement, according to a report of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Pichard said that while he was not present at the first TAVR procedure, he was there for Prof. Cribier’s second. “That day is one trip I did without a suitcase because I flew all night from Washington to Paris, took a taxi to Rouen, they were waiting for me for the procedure, did the procedure,” Pichard said. “Then I went back to the airport and flew back to Washington that evening. “I was so fascinated,” he continued. “I brought pictures that I had taken in the cath lab of the hemodynamics, and I showed them in cath conference. But again, some of my colleagues in Washington said, ‘No, Gus, that’s crazy. That’s not going to work.’ But most people showed great enthusiasm.” During his long friendship and frequent contact with Prof. Cribier, Pichard said, he knew Prof. Cribier “was developing something very creative, very new.” But, Pichard noted, in medicine, advances are often developed independently at more than one center at roughly the same time. “I didn’t think of him as becoming the father of it,” Pichard said when asked if he had any idea that his friend would one day come to be known for such an important advance. “All of us were developing stuff. At the [MedStar Washington] Hospital Center, a group was being very creative, developing stuff. And he had one more tool that sounded very interesting. So I didn’t think at that time that he would be the father of this. Of course, I didn’t know how much it would change cardiology.” To date, Pichard noted, more than 800,000 TAVR procedures have been performed, and in 2023, 98,000 transcatheter aortic valves were implanted in the U.S. Percutaneous Valve Technologies was eventually sold to Edwards Lifesciences. Nadil Dib, MD, MSc, the founder and president of the International Society for Cardiovascular Translational Research, noted that Prof. Cribier was on the society’s governing board. “His feedback and insight was extremely valuable, especially when it comes to innovation,” Dib said. ‘Didn’t slow down’ After retiring from Charles Nicolle University Hospital, Prof. Cribier created the Rouen Medical Training Center and was a professor emeritus at Rouen University, according to the PCRonline profile. “He remained active,” Pichard said. “He kept, not doing cases anymore, but he kept traveling all over the world, doing his lectures, and really didn’t slow down.” Dib said Prof. Cribier was engaged with his profession up to the end of his life. Earlier this month, Prof. Cribier was working on an educational program in India when he spoke with Dib. “I talked to him just a few days before he passed, and he told me that his next step now is that he’s working on the mitral valve,” Dib said. “So for the interventional cardiologists who are working in this field, there is nothing that would be more exciting and rewarding for them to continue what he wanted to do.” “He was always a humanitarian, always global in nature. That can tell you a lot about his ingenuity,” said Dib. “Not only is he genius, but he is also generous,” Dib continued. “His generosity in the education, to share his innovation with other people, that’s what really provided tremendous power to the scientific community to impact the patients’ life worldwide.” Another passion: Music Pichard added that Prof. Cribier had a passion for music. As the PCRonline profile notes, early in life, Prof. Cribier seriously considered becoming a concert pianist. During a conference in Washington, Pichard entertained a group of French cardiologists, including Prof. Cribier, at his house. “He played the piano for us,” Pichard said. “He played Chopin, Beethoven – it was like being at the Lincoln Center.” Pichard added that Prof. Cribier had a Steinway piano in his house, but his wife made him put it in small cottage in the backyard. She told him to practice playing the piano there “because it made too much noise,” though she did allow a smaller piano in the house, which he would occasionally play for guests. “I was shocked about that, but that was part of his life,” Pichard said. “He would go play the piano in the little barn in his backyard.” Despite his wealth, Prof. Cribier maintained a relatively simple lifestyle. “He drove a simple car. He dressed very simple,” Pichard said. “He had no need to show wealth.” Image Credit: Courtesy of Augusto D. "Gus" Pichard, MD Image Caption: Alain Cribier, MD (foreground, left) and Augusto D. "Gus" Pichard, MD, perform a balloon aortic valvuloplasty during the Aortic Valvuloplasty Course at Washington Hospital Center in 1987. This course, a series of seven live cases over 2 days, was the first time the procedure was performed in the U.S.