[We carry out too many TAVI - contra]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) adoption is rising, while surgical aortic valve replacement (SAVR) rates are stable.
• TAVI is increasingly used for patients unsuitable for SAVR.
• Randomized trials indicate survival benefits for TAVI versus conservative care and non-inferiority to SAVR in high-risk groups.

Purpose of the Study:

• To review the efficacy and safety of TAVI compared to SAVR.
• To assess the long-term durability and hemodynamic performance of TAVI valves.
• To evaluate the expanding role of TAVI in various patient risk categories.

Main Methods:

• Analysis of data from randomized controlled trials (e.g., PARTNER, NOTION).
• Review of real-world data from registries (e.g., GARY).
• Examination of subgroup analyses and ongoing prospective trials (e.g., SURTAVI, PARTNER II).

Main Results:

• TAVI demonstrates significant survival benefits compared to conservative therapy.
• TAVI is non-inferior to SAVR in high-risk patients, with some US trials showing survival advantage.
• Long-term data show TAVI valve durability and superior hemodynamics.
• Real-world data and subgroup analyses indicate comparable outcomes for TAVI and SAVR in intermediate and low-risk patients.

Conclusions:

• TAVI is an established, effective treatment for aortic stenosis, offering long-term durability.
• Evidence supports expanding TAVI indications to intermediate and low-risk patients.
• Ongoing trials will further clarify TAVI's role across the risk spectrum.