Authors' objectives: Aortic valve bypass (AVB; apicoaortic conduit) involves the surgical implantation of a valved conduit between the apex of the left ventricle and the aorta, with the objective of relieving obstruction of the left ventricular outflow tract. It has a 40-year history of use in patients with congenital obstructions and idiopathic hypertrophic sub-aortic stenosis and more recently has been adopted for the relief of symptomatic degenerative aortic valve stenosis (AS) in patients who are poor candidates for surgical aortic valve replacement. These patients are also eligible for consideration for transcatheter aortic valve implantation (TAVI). This review was undertaken to determine the health benefits and risks of AVB in adults, and to compare the experience and costs with recent MUHC experience and published results for TAVI.

Authors' recommendations: There is evidence that the AVB procedure is capable of substantially relieving the symptoms, and almost certainly increasing the life expectancy, of patients with severe calcific aortic stenosis. (It is possible that the proposed new procedure for introduction of the apical cannula may further improve outcomes). However, data on which to base prediction of outcomes is insubstantial. The TAVI procedure is currently being successfully carried out at the MUHC. The short-term outcomes of the procedure are better documented. It is possible that some cases may be identified for whom the AVB procedure is preferable to TAVI. But apart from such cases there is no evidence that AVB would be preferable to TAVI when both are feasible. The reported periprocedural mortality and overall mortality of AVB appears to be higher than TAVI, and the rate of pacemaker insertion is lower. AVB and TAVI do not appear to differ substantially in other parameters, including cost.

Project Status: Completed

Year Published: 2011

URL for published report: http://www.mcgill.ca/tau/files/tau/AorticValveBypass_FINAL.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)