Does transcatheter aortic valve implantation improve outcomes compared to surgical replacement in intermediate-low risk patients with aortic stenosis?
This review evaluates the clinical evidence, technical improvements, durability, and cost-effectiveness of transcatheter aortic valve implantation versus surgical replacement in intermediate-low risk patients with aortic stenosis.
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients' risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
Abdelghani et al. (Fri,) studied this question.