Could TAVI Ever Be Primary Choice?

In short

If it’s going to get aired anywhere it’ll be at the European Society of Cardiologists, and it seems like a good time to point out the plain fact that while TAVI is strictly limited in indication and choice of implant (one) in U.S.A, in Germany they’re popping them in like smarties with around 50% of patients over the age of 75 getting the procedure in preference to any other.

Background

It’s only weeks since we pondered the transcatheter aortic valve replacement and the Belgian research paper which suggested the technique’s adoption in Europe was driven more by enthusiasm than by evidence. Our coverage of that article can be found here.

Now, as it’s ESC time, a meeting which has the eyes of the World on it as it discusses a variety of really big issues, from clinical support for Renal Denervation in refractory hypertension to externalised ICD leads, the subject of TAVI adoption has come up.

And guess what. The German registry data (GARY) is looking really pretty good for the technique and suggests that whether by enthusiasm or evidence it is really taking off with 26000 patients now having been treated, some 23% of all potential patients in the period. Indeed the rate of adoption and the low rate of the anticipated complications (cerebrovascular issues and residual aortic regurgitation), combined with ever improving results is encouraging the authors to suggest that “now the risk of patients is going down, more and more, intermediate-risk patients are recommended for the TAVI procedure instead of open-heart surgery.

So if things proceed along this track, might we see the technique being used in a lower risk* population?

The work is reported by theheart.org here

*Lower risk for conventional valve replacement surgery

Source: theheart.org