Guideline
July 21, 2021
JOURNAL：JAMA Cardiol.
Article Link
Guideline Update on Indications for Transcatheter Aortic Valve Implantation Based on the 2020 American College of Cardiology/American Heart Association Guidelines for Management of Valvular Heart Disease
TM Sundt; H Jneid et al.
KEYWORDS
TAVR; valular heart disease; indication; guideline
The continued evolution of transcatheter aortic valve implantation
(TAVI) technology and the results of multiple randomized clinical trials
(RCTs) have firmly established this approach as an alternative to
surgical aortic valve replacement (SAVR) in the treatment of aortic
stenosis in all risk groups. Deciding on TAVI or SAVR depends on
patient-specific factors, including technical, procedure-specific
contraindications and the balance between estimated life expectancy and
anticipated prosthesis durability. These factors pertain to the decision
between mechanical and biological prostheses, and if the choice is
biological, between SAVR and TAVI. A strong emphasis is now placed on
shared decision-making with the patient and involvement of the
multidisciplinary heart team. For most patients younger than 65 years,
SAVR is recommended, with mechanical valves favored in those younger
than 50 years. For those older than 65 years, the perioperative risks of
mortality and stroke are lower with transfemoral TAVI compared with
SAVR, but the risks of paravalvular leak, a pacemaker requirement, and
vascular complications are higher.
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