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Transcatheter aortic valve implantation: The evolving role of surgeons and challenges ahead
Author(s) -
Chow Simon C.Y.,
Wan Innes Y.P.,
Wong Randolph H.L.,
Underwood Malcolm J.
Publication year - 2018
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/1744-1633.12342
Subject(s) - medicine , aortic valve replacement , stenosis , cardiology , intensive care medicine , surgery
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis. Multiple seminal trials have firmly established TAVI as an effective and the preferred treatment in patients at high risk for surgical aortic valve replacement (SAVR). Following the success of the Placement of AoRTic TraNscathetER(PARTNER) 1 trial, TAVI was further proven to be a viable alternative to SAVR, with patients found to be at lower risk in the PARTNER 2 and Surgical or Transcatheter Aortic‐Valve Replacement (SURTAVI) trials. Contrary to the development of coronary intervention, surgeons from many parts of the world have adopted an active role in TAVI, rather than merely providing access. Moreover, as the use of TAVI has increased worldwide, and with developments in techniques and devices, experts are trying to expand the indications of TAVI to patients who are younger, fitter and at low risk for SAVR. Nonetheless, important questions concerning the risks and durability of TAVI remain unanswered. As the evolution of TAVI continues to gather pace, it is important for clinicians to critically evaluate the merits and shortcomings of TAVI to determine its suitability for low‐risk patients. The present review serves to highlight and discuss some of the challenges TAVI needs to overcome before its role in low risk patients can be established.