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Transcatheter Aortic Valve Implantation in High-risk Patients with Severe Aortic Stenosis


In spite of these exciting results, the TAVI technique should not be used indiscriminately; its use should be justified and supported by long-term safety and durability data. The TAVI technique is currently restricted to high-risk patients or those with contraindications for surgery, and further studies will determine the feasibility of extending it to lower-risk patient populations.25


Conclusions


Valve replacement procedures have a significant impact on the prognosis and quality of life of AS patients. Recent improvements in cardiothoracic surgery and percutaneous therapy offer good therapeutic options, even for patients who were traditionally considered as being at very high risk from intervention.


Non-recognition of the progression of mild or moderate AS to severe disease, underestimation of the disease severity, non-referral to surgery and refusal of intervention need to be


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recognised as reasons behind the undertreatment of AS and subsequent suboptimal outcomes.


While SAVR is still the treatment of choice for eligible patients with severe AS, TAVI is considered the new standard of care for patients who are deemed unsuitable for surgery and shows excellent outcomes in patients at high surgical risk. The future should see an expansion of the indications for this technology, which may extend to valve-in-valve procedures to ‘replace’ degenerated bioprosthesis and even to valve-in-ring (valves in mitral or tricuspid rings) applications.


Long-term safety and durability data are expected to become available in the near future. In addition, risk scores specifically adapted for TAVI are under development. Meanwhile, technological advances in valve design and performance, together with smaller delivery systems, will make the procedure safer and decrease the workload of the multidisciplinary TAVI team. n


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EUROPEAN CARDIOLOGY


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