Key result
Transcatheter aortic valve implantation in low-risk patients currently lacks sufficient evidence for long-term durability and cost-effectiveness compared to surgical aortic valve replacement.
Why the study?
To review the evidence and concerns relating to the extension of transcatheter aortic valve implantation usage to low-risk patients.
Should transcatheter aortic valve implantation be used in low-risk patients with aortic stenosis?
Should transcatheter aortic valve implantation be used in low-risk patients with aortic stenosis?
This review cautions against the premature adoption of TAVI in low-risk, younger patients due to unresolved issues with valve durability, pacemaker requirements, and paravalvular leaks.
TAVI should not yet replace SAVR in low-risk patients; leaves open the need for longer-term durability and cost data from RCTs.
BACKGROUND: Review of evidence and concerns, relating to extension of transcatheter aortic valve implantation usage to low-risk patients. METHODS: Comprehensive literature review was conducted identifying articles relating to transcatheter aortic valve implantation. RESULTS: Transcatheter aortic valve implantation is effective in patients with aortic stenosis. Currently, long-term durability and cost-effectiveness are unproven, anticoagulation requirement undefined, permanent pacemaker implantation and paravalvular leak rates higher than following surgical aortic valve replacement. CONCLUSIONS: Current evidence supporting transcatheter aortic valve implantation usage in low-risk patients is insufficient. Extending use now, to this large young patient population is premature, and should be delayed.
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Navaratnarajah et al. (2021) conducted a review in Aortic stenosis in low-risk patients. Transcatheter aortic valve implantation vs. Surgical aortic valve replacement was evaluated. Transcatheter aortic valve implantation in low-risk patients currently lacks sufficient evidence for long-term durability and cost-effectiveness compared to surgical aortic valve replacement.
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