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Clinical practice guideline for transcatheter versus surgical valve replacement in patients with severe aortic stenosis in Latin America
  1. Pablo Lamelas1,2,
  2. Martin Alberto Ragusa3,4,
  3. Rodrigo Bagur5,
  4. Iqbal Jaffer6,
  5. Henrique Ribeiro7,
  6. Adrian Baranchuk8,
  7. Fernando Wyss9,
  8. Alvaro Sosa Liprandi10,
  9. Gabriel Olivares11,
  10. Magaly Arrais12,
  11. Juan Camilo Rendon13,
  12. Jorge Catrip14,
  13. Carla Agatiello15,
  14. Fernando Cura1,
  15. Alfaro Marchena16,
  16. Fabio Sandoli de Brito Jr17,
  17. José A Mangione18,
  18. Aníbal Damonte19,
  19. Omar Santaera20,
  20. Pedro Hidalgo21,
  21. Robby Nieuwlaat22,
  22. Ariel Izcovich3
  23. Endorsed by the Sociedad Latino Americana de Cardiología Intervencionista (SOLACI) and the Sociedad Interamericana de Cardiología (SIAC)
  1. 1 Interventional Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
  2. 2 Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3 Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
  4. 4 Internal Medicine, Hospital General de Agudos Juan A Fernandez, Buenos Aires, Argentina
  5. 5 Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
  6. 6 Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
  7. 7 Medical sciences, University of Sao Paulo, Sao Paulo, Brazil
  8. 8 Medicine, Queen's University, Kingston, Ontario, Canada
  9. 9 Cardiology, Guatemala Cardiovascular Services and Technology, Guatemala, Guatemala
  10. 10 Cardiology, Sanatorio Guemes, Buenos Aires, Argentina
  11. 11 Surgery, Clínica Universidad de los Andes, Las Condes, Chile
  12. 12 Cardiac Surgery, Dante Pazzanese Institute, Sao Paulo, Brazil
  13. 13 Surgery, Clinica CardioVid, Medellín, Colombia
  14. 14 Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, Mexico
  15. 15 Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  16. 16 Cardiology, Clinica Hospital San Fernando, Panama City, Panama
  17. 17 Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  18. 18 Interventional Cardiology, Beneficencia Portuguesa de Sao Paulo, São Paulo, Brazil
  19. 19 Interventional Cardiology, Instituto Cardiovascular de Rosario, Rosario, Argentina
  20. 20 Cardiology, Clinica Privada Provincial de Merlo, Buenos Aires, Argentina
  21. 21 Interventional Cardiology, Policlinica Amado, Maracaibo, Venezuela
  22. 22 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Pablo Lamelas, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina; plamelas{at}icba.com.ar

Abstract

In elderly (75 years or older) patients living in Latin America with severe symptomatic aortic stenosis candidates for transfemoral approach, the panel suggests the use of transcatheter aortic valve implant (TAVI) over surgical aortic valve replacement (SAVR). This is a conditional recommendation, based on moderate certainty in the evidence (⨁⨁⨁Ο).

This recommendation does not apply to patients in which there is a standard of care, like TAVI for patients at very high risk for cardiac surgery or inoperable patients, or SAVR for non-elderly patients (eg, under 65 years old) at low risk for cardiac surgery. The suggested age threshold of 75 years old is based on judgement of limited available literature and should be used as a guide rather than a determinant threshold.

The conditional nature of this recommendation means that the majority of patients in this situation would want a transfemoral TAVI over SAVR, but some may prefer SAVR. For clinicians, this means that they must be familiar with the evidence supporting this recommendation and help each patient to arrive at a management decision integrating a multidisciplinary team discussion (Heart Team), patient’s values and preferences through shared decision-making, and available resources. Policymakers will require substantial debate and the involvement of various stakeholders to implement this recommendation.

  • transcatheter aortic valve replacement
  • aortic valve stenosis
  • heart valve prosthesis implantation

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Footnotes

  • Twitter @lamelaspablo, @Hbribeiro37, @fernando_wyss

  • Correction notice In response to reader queries, the authors have made corrections to their article since it was first published online. The authors have now expanded on the role of SOLACI and the involvement of other societies in this guideline. Sentences have been added to the 'Conflict of interest management and role of the sponsor' section, and a new section has been added entitled 'Involvement of other societies'. Conflicts of interest for external clinical reviewers have now been detailed in the 'Competing interests' section.

  • Contributors PL, MAR, IJ and AI developed and oversight the whole process of the guideline. RB and HR collaborated as topic experts. AB, FW, ASL, GO, MA, JCR, JC, CA, FC, AM and FSB collaborated as panelists. JAM, AD, OS and PH approved from Sociedad Latino Americana de Cardiología Intervencionista in the quality assurance process. RN collaborated in the design phase and then made major contributions during the review.

  • Funding Sociedad Latino Americana de Cardiología Intervencionista (SOLACI) covered costs related to the systematic review and data abstraction. SOLACI authorities had no involvement in the process of the guideline until quality assurance following the external review.

  • Competing interests FSB: proctoring fees from Edwards LifeSciences, Medtronic and Boston Scientific. CA, MA, FC: proctoring fees from Edwards LifeSciences and Boston Scientific. Participants without voting rights: PL: proctoring fees from Edwards LifeSciences, Medtronic, Boston Scientific (significant); consulting fees Boston Scientific (not significant). HR: proctoring fees from Edwards LifeSciences, Boston Scientific and Medtronic, and research grants from Edwards LifeSciences, Boston Scientific and Medtronic. Clinical external reviewers: MT: Nothing to declare. OM: Consulting honoraria from Medtronic, Boston Scientific and Philips. CR: Nothing to declare.

  • Patient and public involvement statement Patients were included in the guideline panel

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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