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Trans-catheter aortic valve implantation in the United Kingdom: NICE guidance
  1. Martyn Thomas
  1. Dr Martyn Thomas, Guys and St Thomas’ NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK; Mttwins{at}aol.com

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As the elderly population has grown, so symptomatic aortic stenosis has become an increasing problem with a poor prognosis if untreated.1 2 Trans-catheter aortic valve implantation (TAVI) has been designed to treat patients who would be at high risk during standard cardiac surgery. TAVI allows aortic valve implantation without the need for a sternotomy or cardiopulmonary bypass. The procedure may be performed from the femoral or trans-apical approach depending on the calibre of the peripheral vascular vessels and the device being used. The first human procedure was performed in 2002 and recently two devices have received a CE mark. The Edwards Sapien valve and the Corevalve are now available for commercial use in the United Kingdom. The Edwards valve is a balloon-expandable valve delivered either from the transfemoral or transapical (left 5th/6th intercostals space) approach, while the Corevalve is a self-expanding device which currently can only be delivered by the transfemoral or transaxillary approach. The procedure is usually (but not always) carried out under a general anaesthetic and during the transfemoral approach the femoral artery is usually (but not always) closed by an open surgical technique.

Surgical aortic valve replacement (AVR) is undoubtedly the “gold standard” procedure for symptomatic aortic stenosis with excellent short-term and long-term results, even in high-risk patients.2 3 Despite this, surveys have shown that many patients are excluded from this procedure, often because of co-morbidities.4 The prognosis in these patients is poor. The need …

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