Journal
EUROPEAN HEART JOURNAL
Volume 43, Issue 29, Pages 2729-+Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehac105
Keywords
Transcatheter aortic valve implantation; Surgical aortic valve replacement; Lifetime management
Categories
Funding
- Abbott
- Amgen
- Astra Zeneca
- BMS
- Bayer
- Biotronik
- Boston Scientific
- Cardinal Health
- CardioValve
- CSL Behring
- Daiichi Sankyo
- Edwards Lifesciences
- Guerbet
- InfraRedx
- Johnson Johnson
- Medicure
- Medtronic
- Novartis
- Polares
- OrPha Suisse
- Pfizer
- Regeneron
- sanofi-aventis
- Sinomed
- Terumo
- V-Wave
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Transcatheter aortic valve implantation (TAVI) has become a standard treatment option for patients with severe symptomatic aortic valve stenosis (AS). The selection between TAVI and surgical aortic valve replacement (SAVR) should be made by a multidisciplinary heart team, considering clinical and anatomical factors as well as patient preferences and lifetime management.
Transcatheter aortic valve implantation (TAVI) has matured into a standard treatment option for patients with severe symptomatic aortic valve stenosis (AS) across the whole spectrum of risk. The advances in the interventional treatment of AS raise the question of which patients with severe AS should be referred to surgery. The myriad of clinical permutations does not allow providing a single, uniform treatment strategy. Rather, the advent of TAVI along with established surgical aortic valve replacement (SAVR) fundamentally enforces the role of the multidisciplinary heart team for decision-making recommending the best individual choice of the two options based on a thorough review of clinical and anatomical factors as well as lifetime management considerations. Involvement of the informed patient expressing treatment preferences is a key for a shared decision-making process. Herein, we provide an in-depth review of evidence informing the decision-making process between TAVI and SAVR and key elements for treatment selection. Special attention is given to the populations that have been excluded from randomized clinical trials, and also lifetime management strategies of patients with severe AS are proposed.
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