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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review

Tristan D Yan1, Christopher Cao, Julie Martens-Nielsen

  • 1Department of Cardiothoracic Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney 2050, Australia. Tristan.Yan@unsw.edu.au

The Journal of Thoracic and Cardiovascular Surgery
|October 23, 2009
PubMed

Insights

Transcatheter aortic valve implantation shows short-term efficacy for severe aortic stenosis but carries risks. Long-term outcomes remain uncertain, necessitating cautious use within clinical trials.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Technology Assessment

Background:

  • Severe aortic stenosis poses significant risks for patients unsuitable for traditional surgery.
  • Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment option.

Purpose of the Study:

  • To systematically review the safety and clinical effectiveness of TAVI in high-risk patients with severe aortic stenosis.
  • To assess the feasibility, safety, efficacy, and durability of TAVI based on available evidence.

Main Methods:

  • Conducted systematic electronic searches across 6 databases from January 2000 to March 2009.
  • Synthesized clinical effectiveness through narrative review and tabulation of results from observational studies.
  • Focused on short-term outcomes due to evidence limitations.

Main Results:

  • Procedural success rates for TAVI ranged from 74% to 100%.
  • Significant short-term adverse events were noted, including mortality (0%-25%) and major cardiovascular events (3%-35%).
  • Echocardiographic improvements in valve area and pressure gradients were observed, with no significant deterioration during follow-up.

Conclusions:

  • TAVI demonstrates short-term efficacy for severe aortic stenosis, evidenced by improved hemodynamic parameters.
  • The procedure carries a potential for serious complications, and long-term outcome data is limited.
  • Current evidence suggests TAVI should be primarily considered within the context of clinical trials.
Abstract

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