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Are the standard criteria for TAVI too lax or too strict?
  1. Jan Kovac (jankovac2{at}hotmail.com)
  1. University Hospitals of Leicester, United Kingdom
    1. Julia H Baron (julia_baron1{at}hotmail.com)
    1. Derbyshire Royal Infirmary, United Kingdom
      1. Derek T Chin (dtchin{at}gateway.net)
      1. University Hospitals of Leicester, United Kingdom

        Abstract

        Transcatheter aortic valve implantation (TAVI) offers considerable promise in treating patients with aortic stenosis (AS) who are at high risk with conventional aortic valve replacement (AVR). Selection criteria for TAVI are clinical and anatomical. As this technology is still new, manufacturers play an important role in validating patient anatomical criteria in relation to prosthesis specification (label information).

        Assessment of anatomical variables is very detailed. Attention needs to be paid to precise measurement of annular dimensions. Imprecise sizing brings risk of misplacement, embolization, aortic regurgitation, aortic rupture, tamponade, or need for postdilatation or 2nd valve in valve. Recommended annular dimensions should be followed as strictly as possible, especially as longer term results of suboptimal implant are uncertain. Detailed assessment of other parameters such as the vasculature and distance to the coronary ostia should also be made.

        Assessment of clinical risk and suitability for TAVI should be by multidisciplinary team (MDT). The team should consist of cardiac surgeons, imaging and interventional cardiologists and a cardiac anaesthetists. Risk can by defined by patient factors present (age being the most common but not exclusive one ) and significant co-morbidities, and assessment of the “potential to improve” post procedure should also be made. For frailty and general patient assessment involvement of a geriatrician is desirable. Local results for surgical AVR should also be considered. This is good clinical practice, while evidence is being built via RCT and registries. Currrent criteria are neither too strict or lax, but appropriate for a novel technology with a limited evidence base.

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