The UK TAVI trial: an independent, pragmatic study extending the evidence for the treatment of symptomatic severe aortic stenosis

Comment on ‘Effect of Transcatheter Aortic Valve Implantation vs. Surgical Aortic Valve Replacement on All-Cause Mortality in Patients with Aortic Stenosis: A Randomized Clinical Trial’ which was published in the Journal of the American Medical Association, https://doi.org/10.1001/jama.2022.5776. Over the past two decades, accumulating evidence from randomized clinical trials (RCTs) comparing TAVI vs. SAVR provided the basis for a fundamental paradigm shift in therapeutic approach to symptomatic severe aortic stenosis.2–4 TAVI has become the recommended treatment for the patients deemed to be at high risk for conventional surgery,5 and the results of landmark trials in patients at intermediate or low surgical risk have been gradually extending the indication of the transcatheter approach across the whole spectrum of predicted surgical risk.4,5 Most of these trials were sponsor-initiated, involved only selected institutions, and mandated the use of specific valve types, thus limiting the generalizability of the results.2,3