How is the TAVI procedure performed?
Year-on-year, the use of TAVI in patients with severe aortic stenosis is increasing. In Europe, this growth resulted in 39,931 TAVI procedures performed in 2016, compared with 10,660 in 20121 and following expansion of the patient cohort indicated for treatment with transfemoral TAVI,2 this is likely to increase further in the coming decade, potentially becoming the standard of care for many patients with severe aortic stenosis.3
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),4 which is possible when the patient has suitable iliofemoral anatomy and does not suffer from other vessel disease.5
Iterative improvements in TAVI valve and delivery systems have contributed to the increased suitability of patients for transfemoral TAVI and the increased numbers of TAVI procedures.3
Transcatheter aortic valve implantation
TAVI may be advantageous compared with surgery
The recently released results of the PARTNER 3 Trial proves SAPIEN 3 TAVI is superior to surgery on the primary endpoint (all-cause death, all stroke, and rehospitalization) and multiple pre-specified secondary endpoints. Learn more about PARTNER 3.
Compared with open heart surgery, TAVI may offer the following benefits:
- is less invasive9
- is a shorter procedure10
- reduces patient time in intensive care7
- offers shortened recovery time11
- leads to less pain and a shorter hospital stay12,13
- offers a more rapid improvement in quality of life13
TAVI has a low risk of major adverse cerebrovascular and cardiac events.14 Furthermore, stable valve durability has been demonstrated up to 5 years of follow-up.6, 15
SAPIEN 3 TAVI is now approved for use in low-risk patients with severe aortic stenosis.
- BIBA. International transcatheter aortic valve implantation (TAVI) monitor. EUROSTAT database; TAVI procedures in Europe from 2012–2017.
- Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38: 2739-2791.
- Hamm CW, Arsalan M, Mack MJ. The future of transcatheter aortic valve implantation. Eur Heart J 2016; 37: 803-810.
- Piazza N, Windecker S. The “hidden experiment”: percutaneous vs. surgical cut-down for transfemoral transcatheter aortic valve implantation. EuroIntervention 2017; 12: 1925-1926.
- Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: part 1: basic anatomy, imaging, sheaths, wires, and access routes. JACC Cardiovasc Interv 2013; 6: 643-653
- Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015; 385: 2477-2484.
- Leon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. New England Journal of Medicine 2016; 374: 1609-1620.
- Thourani VH, Kodali S, Makkar RR,et al. Transcatheter aortic valve replacement vs. surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 2016;387:2218–25.
- Raiten JM, Gutsche JT, Horak J, et al. Critical care management of patients following transcatheter aortic valve replacement. F1000Research 2013; 2: 62.
- Hamm CW, Möllmann H, Holzhey D, et al. The German Aortic Valve Registry (GARY): in-hospital outcome. Eur Heart J 2014; 35: 1588-1598.
- Kleczynski P, Bagienski M, Sorysz D, et al. Short- and intermediate-term improvement of patient quality of life after transcatheter aortic valve implantation: a single-centre study. Kardiologia polska 2014; 72: 612-616.
- Minutello RM, Wong SC, Swaminathan RV, et al. Costs and in-hospital outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in commercial cases using a propensity score matched model. The American journal of cardiology 2015; 115: 1443-1447.
- Reynolds MR, Magnuson EA, Wang K, et al. Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A). J Am Coll Cardiol 2012; 60: 548-558.
- Tamburino C, Barbanti M, Capodanno D, et al. Comparison of complications and outcomes to one year of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis. The American journal of cardiology 2012; 109: 1487-1493.
- Foroutan F, Guyatt GH, Otto CM, et al. Structural valve deterioration after transcatheter aortic valve implantation. Heart 2017.
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