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.