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Controversial issues in transcatheter aortic valve implantation

  • Patient selection beyond scoring, presented by B Iung (Paris Cedex 18, FR) - Slides
  • Surgery in patients unsuitable for TAVI, presented by T Walther (Bad Nauheim, DE) - Slides
  • Off-label and/or compassionate use, presented by P MacCarthy (London, GB)
  • Current indications for the transapical approach, presented by V Falk (Zurich, CH) - Slides 
Valvular Heart Diseases

Patient selection beyond scoring

Bernard Iung began his presentation by showing the growing use of TAVI (>30 000 implanted) and explained the issues of a proper patient selection for TAVI. He emphasized the problem of identifying high risk patients: the scores used in routine practice are not adapted to predicting the risk of the procedure especially in high risk patients. Frailty, comorbidities, functional and cognitive capacities are identified as major criteria of prognosis. He explained the major criteria (clinical, angiographic, echocardiographic) needed for patient screening and selection and the need for a multidisciplinary approach.

Surgery in patients unsuitable for TAVI

Thomas Walther showed results from the German registry with an increasing rate of TAVI up to 23.9% in 2010 associated with a stable to mild reduction of surgical aortic valve replacement.he focused on the predictors of complications (left main compression by excessive cusp calcification, risk of stroke…during TAVI procedures. He differentiated screening and selection of patients, all comers and selection, and insisted on the risk of patients on waiting list. He showed the new generation of percutaneous valves which could reduce complication rate.

Off label and/or compassionate use

Phil MacCarthy demonstrated the importance of patient selection, determination of risk profile which is unique for each patient, clinical judgement, multidisciplinary approach and the heart team. He defined what can we call on-label and off label (patient with inaccurate score calculation, bicuspide valve, severe mitral regurgitation, valve in valve intervention, prior mitral valve prosthesis) insisting on different issues of off-label indication.

Current indications for the transapical approach

Volker Falk concluded this excellent session showing indications, technique, technical refinements and very positive results of surgical transapical approach.




Controversial issues in transcatheter aortic valve implantation

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.