[Transcatheter aortic valve implantation for severe aortic stenosis]

Alfie V, Alcaraz A,Pichon-Riviere A, Augustovski F, García Martí S, Bardach A, Ciapponi A.
Record ID 32018001507
Spanish
Original Title: Implante valvular aórtico por cateterismo en estenosis aórtica severa
Authors' recomendations: CONCLUSIONS In patients with symptomatic and inoperable severe aortic stenosis (AoS), high-quality evidence shows that transcatheter aortic valve implantation (TAVI) has lower mortality rates, better cardiac function and better quality of life when compared with symptomatic treatment, although it has a higher risk of stroke and major procedure-related complications. In patients with severe symptomatic AoS and at high surgical risk, high-quality evidence on TAVI use versus conventional surgical aortic valve replacement, did not show differences in mortality rate for all causes, stroke and infarction between both treatments. At short-term, quality of life was better. Nonetheless, TAVI was associated to a higher risk of moderate to severe paravalvular regurgitation and permanent pacemaker implantation. In patients with severe symptomatic AoS and at intermediate surgical risk, high-quality evidence on TAVI use compared with conventional surgical aortic valve replacement, shows that the mortality rates and stroke at middle and short term are similar, although there is a higher risk of residual paravalvular regurgitation and the need for pacemaker implantation. For low-risk patients, the results are similar, but with a shorter follow-up. The clinical practice guidelines assessed agree on recommending TAVI for patients with severe aortic stenosis with contraindication for surgical valve replacement, pointing out that the procedure should only be performed at centers by teams with technical experience both in the placement and management of perioperative complications. In high-risk patients, TAVI is a treatment option as well as open surgery, and there is not uniformity on recommending it for moderate or low-risk patients. State sponsors from high-income countries cover TAVI for inoperable patients. Some United States private sponsors cover the procedure in high-risk patients. In Latin-America, Argentina includes this technology in the Unique Reimbursement System for inoperable and high-risk patients. Uruguay, Brazil, Chile and Colombia do not cover its use. In Argentina, the cost-effectiveness of the procedure is unknown.
Details
Project Status: Completed
Year Published: 2018
URL for published report: https://www.iecs.org.ar/home-ets/
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Aortic Valve Stenosis
  • Heart Valve Prosthesis Implantation
  • Transcatheter Aortic Valve Replacement
Contact
Organisation Name: Institute for Clinical Effectiveness and Health Policy
Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name: info@iecs.org.ar
Contact Email: info@iecs.org.ar
Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)
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