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Thirteen years following the first human transcatheter aortic valve implantation (TAVI),1 the procedure is now established as a proven therapy for patients with symptomatic severe aortic stenosis (AS) who are at high or excessive risk for conventional surgical aortic valve replacement (AVR). Remarkable efficacy demonstrated in pivotal randomised controlled studies2 ,3 has been confirmed within large-scale, real-world international multicentre registries, and TAVI is now approved by regulatory bodies and embedded within international guidelines as a Class I recommendation. More than 100 000 TAVI procedures have now been performed worldwide.
A predictable consequence of this widely publicised success story is the move to consider the wider use of TAVI in patients conventionally treated by means of open surgery, either as a result of physician preference or patient choice. While further randomised controlled trials to evaluate TAVI in intermediate or low-risk cohorts are planned or underway, valid long-term outcome data concerning the durability of percutaneously implanted valves will ultimately determine whether TAVI becomes the default treatment of choice for the majority of patients with AS.
Decision making in AS
Patients with AS are frequently elderly and frail with attendant comorbidity, and selection of the optimal treatment option is frequently challenging as a consequence. The development of a robust ‘Heart Team’ to evaluate, discuss and treat these patients is a fundamental principle of a successful TAVI service, and this multidisciplinary approach is strongly endorsed by the European Society of Cardiology and American College of Cardiology/American Heart Association Guidelines on Valvular Heart Disease. Guiding a patient and their family in the choice between AVR and TAVI (or no intervention in some patients where high-risk intervention …