Patient selection for TAVI in 2014: is it justified to treat low- or intermediate-risk patients? The cardiologist’s view

Twelve years after the first transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), European and American guidelines, as well as the FDA, indicated that TAVI is the treatment of choice in "inoperable" patients and an alternative option to SAVR in high-risk patients. Recently, there has been a trend in clinical practice and trials to treat "lower" risk patients, and data in this subset of patients suggest better outcomes with TAVI, equivalent to surgery, using propensity matching analysis. The awaited results of the randomised PARTNER II trial with the Edwards XT valve and of the SURTAVI trial with the Medtronic CoreValve will bring an evidence-based comparison of TAVI versus SAVR in this patient population. Refinement in patient selection, new devices and long-term assessment of valve durability should also contribute to an extension of the indication of TAVI to "lower" risk patients. It is likely that the next five to ten years will see this technology become the dominant therapy for AS. At the present time, one might already consider TAVI as an alternative to SAVR in a select subset of very old and otherwise healthy AS patients.