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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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.
Patient and public involvement statement Patients were included in the guideline panel
Provenance and peer review Not commissioned; externally peer reviewed.
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