TAVI is considered an alternative to SAVR in high-risk and select very old, otherwise healthy patients with severe aortic stenosis, while trials in lower-risk populations are ongoing.
Is it justified to treat low- or intermediate-risk patients with severe aortic stenosis using TAVI compared to SAVR?
TAVI may become an alternative to SAVR in select lower-risk or very old, otherwise healthy patients with severe aortic stenosis, pending further trial data.
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.
Cribier et al. (Mon,) conducted a review in Severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated. TAVI is considered an alternative to SAVR in high-risk and select very old, otherwise healthy patients with severe aortic stenosis, while trials in lower-risk populations are ongoing.