Intervention options

Cardologist-discussing-intervention-options

Choice of intervention for severe aortic stenosis

After referral to the Heart Team a decision to utilise sAVR or TAVI will be made. It is dependent on estimated surgical risk and based on a patient’s clinical characteristics, anatomical and technical aspects as well as any coexisting cardiac conditions that may require concomitant intervention. 2

Both sAVR and TAVI procedures are used to achieve adequate haemodynamic parameters and relief of symptoms with improved survival.

How is the TAVI procedure performed?

The TAVI procedure can be performed through several access routes, most commonly via the transfemoral approach (utilised in more than 90% of patients at most centres). This approach is possible when the patient has suitable iliofemoral anatomy and does not suffer from other vessel disease.6,7
Iterative improvements in TAVI valves and delivery systems have contributed to the increased suitability of transfemoral TAVI for patients, resulting in an increasing number of TAVI procedures.8
Transfemoral-approach-animation
Transfemoral approach for TAVI using balloon-expandable technology.
2 min

The sAVR or TAVI decision

The choice of intervention must be based on careful individual evaluation of technical suitability and weighing of risks and benefits of each treatment. In addition, the local expertise and outcomes data for the given intervention must be taken into account.2

sAVR may be favourable in patients which have:

savr

TAVI may be favourable in patients which have:

Adapted from the 2017 ESC/EACTS Guidelines for the management of valvular heart disease.

The future of symptomatic severe aortic stenosis management

The role of TAVI in the treatment of patients with ssAS has evolved based on evidence from clinical trials showing efficacy irrespective of surgical risk. Over the past few years, over 500,000 TAVI procedures have been performed in more than 70+ countries. With the TAVI indication expanding to low-risk patients and with evidence for longer durability, procedure numbers are expected to continue rising.5,9-11 

Number-of-TAVI-procedures-per-year-graph
See the full evidence for TAVI in sAS patients within the low-risk PARTNER 3 Trial

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References

  • 1 Kolkailah AA, et al. Cochrane Database Syst Rev. 2019;12(12):CD013319.
  • 2 Baumgartner H, et al. Eur Heart J 2017;38(36):2739–2791.
  • 3 Cahill TJ, et al. Eur Heart J. 2018 Jul 21;39(28):2625-2634.
  • 4 Brown JM, O’Brien SM, et al. J Thorac Cardiovasc Surg 2009;137:82–90.
  • 5 Costa G, et al. Cardica Interv Today 2018;12(2):51-54.
  • 6 Piazza N, et al. JACC Cardiovasc Interv 2013;803-810.
  • 7 Togweiller S, et al. JACC Cardiovasc Interv 2013;6:643-653.
  • 8 Hamm CW, et al. Eur Heart J 2016;37:803-810.
  • 9 Mack MJ, et al. N Engl J Med. 2019;380:1695–1705.
  • 10 Mack MJ. Two-year clinical and echocardiographic outcomes from the PARTNER 3 low-risk randomized trial. Presented at: ACC 2020, Chicago, March 29,2020.
  • 11 Mack MJ, et al. Lancet 2015;385:2447–2484.

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