Breaking the Barrier: The Benefits and Drawbacks of TAVI in Low-Surgical Risk Patients

18/07/2023

Take Home Messages
Transcatheter aortic valve implantation (TAVI) is a well-established therapy for patients with severe aortic stenosis (AS) where traditional surgical aortic valve replacement surgery (SAVR) carries intermediate or higher operative risk. (ACS). Recent trials have shown that TAVI is non-inferior and even superior to SAVR in patients with low surgical risk. However, concerns remain that any complications could have a greater long-term impact on younger patients. There is favourable 8-year TAVI valve longevity data with non-inferiority to bioprosthetic surgical valve longevity. Conduction disorders, aortic regurgitation, coronary artery access and considerations of future approaches to repeat aortic valve intervention remain the key obstacles. Cardiologists in Heart Teams will need to consider not only the immediate patient care but also anticipate future developments and challenges to ensure optimal outcomes for their patients in the lifelong management of AS.

Take Home Messages

Transcatheter aortic valve implantation (TAVI) is a well-established therapy for patients with severe aortic stenosis (AS) where traditional surgical aortic valve replacement surgery (SAVR) carries intermediate or higher operative risk. (ACS).
Recent trials have shown that TAVI is non-inferior and even superior to SAVR in patients with low surgical risk. However, concerns remain that any complications could have a greater long-term impact on younger patients.
There is favourable 8-year TAVI valve longevity data with non-inferiority to bioprosthetic surgical valve longevity.
Conduction disorders, aortic regurgitation, coronary artery access and considerations of future approaches to repeat aortic valve intervention remain the key obstacles.
Cardiologists in Heart Teams will need to consider not only the immediate patient care but also anticipate future developments and challenges to ensure optimal outcomes for their patients in the lifelong management of AS.

Introduction

Within two decades of its inception, transcatheter aortic valve implantation (TAVI) has emerged as a well-established treatment modality for patients diagnosed with severe aortic stenosis (AS), particularly in cases where conventional surgical aortic valve replacement (SA VR) poses intermediate or higher operative risk (1,2). Recent studies provide evidence indicating non-inferiority or even superiority of TAVI over SAVR in patients with low surgical risk, thus broadening the eligible patient population for TAVI (3,4). Despite encouraging 2-year outcomes (Table 1), the use of TAVI in younger, low surgical risk populations raises concerns regarding long-term complications which would have a greater impact on younger patients. Specifically, low-risk TAVI trials have demonstrated that certain complications are more frequent with TAVI when compared to SAVR, which could lead to undesirable cumulative effects with increased life expectancy. The landscape of TAVI has changed since previous reviews in 2019 (5,6) thus here I will revisit the literature and discuss these complications and other possible drawbacks of TAVI's widespread future use.

Breaking the Barrier: The Benefits and Drawbacks of TAVI in Low-Surgical Risk Patients

Introduction

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