[Which indications and access routes for transcatheter aortic valve implantation? Health technology assessment from...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe symptomatic aortic stenosis necessitates intervention.
• Transcatheter aortic valve implantation (TAVI) offers an alternative to surgical valve replacement.
• Patient selection is critical for TAVI outcomes.

Purpose of the Study:

• To define the appropriate patient population for TAVI.
• To outline the multidisciplinary team approach for TAVI eligibility assessment.
• To clarify current reimbursement and indication limitations for TAVI.

Main Methods:

• Review of current guidelines and clinical evidence for TAVI.
• Emphasis on multidisciplinary heart team evaluation.
• Consideration of surgical risk scores, comorbidities, anatomy, and frailty.

Main Results:

• TAVI is indicated for severe symptomatic aortic stenosis patients with contraindications to surgical replacement.
• A heart team, including cardiac surgeons and interventional cardiologists, must assess eligibility.
• Long-term efficacy data is still limited, and current indications are restricted.

Conclusions:

• TAVI should be reserved for high-risk surgical patients with severe symptomatic aortic stenosis.
• Strict adherence to contraindications and CE mark instructions is essential.
• Reimbursement for TAVI outside current indications, such as in lower-risk patients, is not supported by current evidence.