Key result
TAVI introduction is linked to increased SAVR volume alongside widespread reductions in early surgical mortality.
Why the study?
To explore the effect of the introduction of TAVI on referral for SAVR regarding volume, patient profile, early outcome, and mechanical heart valve use.
Does the introduction of TAVI affect the volume, patient profile, and outcomes of patients referred for surgical aortic valve replacement?
Systematic Review
Yes
Does the introduction of TAVI affect the volume, patient profile, and outcomes of patients referred for surgical aortic valve replacement?
The introduction of TAVI was paradoxically associated with an increase in surgical aortic valve replacement volume in many centers, potentially reflecting a 'halo effect' and broader access to care through heart team evaluations, alongside improved surgical outcomes.
Transcatheter aortic valve implantation (TAVI) was first presented in 2002 as a case report. Randomized controlled trials showed that TAVI could serve as an alternative for surgical aortic valve replacement (SAVR) in high-risk patients. While the indications for TAVI have expanded into low-risk groups, favorable results of SAVR in elderly showed an increase in application of surgical treatment in this age category. This review aims to explore the effect of the introduction of TAVI in the referral for SAVR with respect to volume, patient profile, early outcome, and use of mechanical heart valves. Results show that the volume of SAVR has increased in several cardiac centers. In a small minority of series, age and risk score of the referred patients also increased. In most of the series, early mortality rate reduced. These findings, however are not universal. Different management policies could be responsible for this observation. Moreover, some patients in whom aortic valve replacement in whatever form is indicated still do not receive adequate treatment. This can be due to several reasons. Heart teams consisting of interventional cardiologists and cardiac surgeons should become a universal approach in order to minimize the number of untreated patients.
No takes yet. Share an insight, caveat, or question.
Wilhelm Mistiaen (2023) conducted a systematic review in Aortic Valve Disease. Introduction of TAVI (Post-TAVI era) vs. Pre-TAVI era was evaluated on Temporal trends in SAVR volume, patient profile, and early mortality. The introduction of TAVI was associated with an increase in surgical aortic valve replacement volume in most series and a widespread reduction in early surgical mortality, despite mixed trends in patient age and risk scores.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: