Introduction
TAVI was first described in 2002, as a salvage procedure in the context of cardiogenic shock secondary to severe Aortic Stenosis (AS).(1) Following it successful utilisation the procedure developed further to become a routine method for management of aortic valve disease. The technology surrounding TAVI and the indications for the procedure are rapidly developing. Originally the procedure was reserved for Supra-specialised tertiary and quaternary centres, but with demonstration of efficacy and safety the technology is moving outward to less specialised peripheral centres.
TAVI is often compared against surgical Aortic Valve Replacement (sAVR). This competitive approach to analysis is inherently biased. The technical procedure of a TAVI is vastly different to that of a sAVR, as such it has different risk to reward ratio. The two procedures should be thought of as complementary interventions on the increasing spectrum of management options for aortic valve disease.
The Placement of Aortic Transcatheter Valve (PARTNER) Trials were the corner stone of understanding the strengths and weaknesses of TAVI in clinical practice. The PARTNER trail was a multi-centred, randomized control trial that examined the safety and efficacy of TAVI vs sAVR in High-risk surgical patients.(2) The PARTNER Trial demonstrated that in high-risk patients, TAVI had lower rates of acute all-cause mortality in 30 days than sAVR (3.4% vs 6.5%). TAVI however was consistently associated with more stroke, major vascular complications, heart-block, pacemaker dependence and para-valulvar leak. Importantly at one-year, mortality between sAVR and TAVI was equivocal. sAVR expectedly demonstrated higher rates of bleeding and atrial fibrillation (AF). (3, 4) Understanding the risk profile of these procedures is fundamental assessing the most appropriate intervention in practice for a given patient.