Transcatheter aortic valve replacement

From Ganfyd

Transcatheter aortic valve replacement (TAVR, transcatheter aortic valve implantation, TAVI) is a technique usually using a femoral-artery based balloon expandable stainless steel stent frame that houses a percardial valve replacement. Accordingly successful TAVR prevents the need for open heart surgery and in those patients not fit for open heart surgery it can be an attractive option. An alternative to the femoral approach uses a transapical approach via a small thoracotomy incision. These two approaches are not equivalent and as of 2012 the transapical approach can be thought equivalent in quality of life outcome to traditional aortic valve replacement while the femoral approach may have relative advantages^[1]. Complications such as stroke rate seem to vary by procedure.

• Outcomes are favourable in those not fit for standard surgery up to 2 years.^[2][3][4]
• One year survival of 80% in early series^[5] but the best European registry is closer to 95.8% at 30 days^[6]

European registry data has shown marked difference in mortality between countries that is unexplained ^[6]. The mortality rate appears to be higher in countries where the procedure is more popular per head of population. This observation would be consistent with either more use outside evidence base or more transapical use, and indeed some countries with higher mortality have more use of apical TAVIs. As of 2012 the cost effectiveness is unclear^[7].

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