Devices and desires

In the wake of concern over breast implants and metal-on-metal hip replacements comes a warning about a new minimally invasive approach to aortic valve replacement. In this week’s BMJ Hans Van Brabandt and colleagues argue that transcatheter aortic valve implantation (TAVI) “cannot be justified on medical or cost effectiveness grounds” (doi:10.1136/bmj.e4710). Since TAVI was introduced 10 years ago, there have been around 40 000 procedures worldwide. “But,” say the authors, “serious unanswered questions remain over the clinical effectiveness of TAVI, as well as the regulatory process that enabled it to gain such a large market so rapidly, particularly in Europe.” So what are the risks? The authors cite evidence that …