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Transatlantic perspectives on TAVI: from essential infrastructure and integration to expansion, research and development
  1. Bernard D Prendergast1,
  2. Christoph K Naber2,
  3. Jeffrey J Popma3
  1. 1Department of Cardiology, The John Radcliffe Hospital, Oxford, UK
  2. 2Department of Cardiology and Angiology, Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
  3. 3Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Bernard D Prendergast, Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, UK bernard.prendergast{at}ouh.nhs.uk

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Introduction

Transcatheter aortic valve implantation (TAVI) is arguably the greatest advance in interventional cardiology since the introduction of drug eluting stents in the 1990s. Results from multicentre randomised controlled trials clearly demonstrate both the superiority of the technique in comparison to medical therapy (with or without balloon valvuloplasty) in patients deemed unsuitable for conventional surgery,1 and its broad equivalence to conventional surgical aortic valve replacement (AVR) in high risk patients suitable for an open surgical or percutaneous approach.2 Emerging cost-effectiveness data demonstrate the advantages of a shorter intensive care unit stay, rapid mobilisation and early hospital discharge, and future trials coupled with further technological developments seem certain to confirm the place of TAVI in the routine treatment of higher risk and elderly patients with aortic stenosis.

However, conventional AVR is a well established procedure with excellent acute and long term outcomes in well selected patients. Premature expansion of TAVI into lower risk cohorts and its performance in non-specialist centres with inadequate support facilities (including cardiac surgery, vascular radiology and renal dialysis) may result in outcomes which are inferior to those reported in randomised controlled trials and registries to date, and jeopardise the further successful development of the procedure. There is therefore a need for robust governance frameworks to regulate the performance of TAVI in routine clinical practice and to ensure that the excellent results associated with early development of the procedure are maintained to support the continued global rollout of this ground breaking technology.

Two currently available documents prepared by Working Groups of the European Society of Cardiology,3 and the combined forces of the British Cardiovascular Intervention Society (BCIS) and Society of Cardiothoracic Surgeons (SCTS),4 provide clear recommendations which underpin current practice in Europe. Recent surveys conducted within the UK indicate that these standards are accepted and …

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