[Transcatheter aortic valve implantation in severe aortic stenosis]

Mengarelli C, García Marti S, Colaci C, Alfie V, Ciapponi A, Bardach A, Augustovski F, Alcaraz A, Pichon-Riviere A
Record ID 32018002330
Spanish
Original Title: Implante valvular aórtico por cateterismo en estenosis aortica severa
Authors' recomendations: In patients with symptomatic and inoperable severe aortic stenosis (AoS), high-quality evidence shows that transcatheter aortic valve implantation (TAVI) shows lower mortality, better heart function and better quality of life when compared with symptom-based supportive treatment; however it shows higher risk of stroke and major complications associated to the procedure. In high-risk surgical patients with symptomatic severe AoS, high-quality evidence on the use of TAVI versus conventional aortic valve replacement surgery, did not show differences in mortality for any cause, stroke and infarction when comparing both treatments. At short term, the quality of life of the patients who underwent TAVI was better. However, TAVI was associated to a higher risk of moderate to severe paravalvular regurgitation, and need for permanent pacemaker implantation. In intermediate-risk surgical patients with severe symptomatic AoS, high-quality evidence on the use of TAVI versus conventional aortic valve replacement surgery, shows that mortality rates and stroke at short, mid and long term are similar, although with a higher risk for residual paravalvular regurgitation and need for pacemaker implantation. In the case of AoS patients over 90 years old, low-quality evidence shows that mortality rates with the use of TAVI are higher when compared with patients under 80. The clinical practice guidelines consulted agree on recommending TAVI in patients with severe aortic stenosis and contraindication for surgical valve replacement, specifying that this procedure should only be carried out at sites having teams technically trained both in implantation and management of periprocedural complications. In high-risk patients, TAVI is considered a treatment option as well as open surgery. There is not an agreed recommendation in moderate to low risk patients. In patients under 65 years old, requiring aortic valve replacement and asymptomatic, surgery is recommended. In patients between 65 and 80 years old with symptomatic aortic stenosis, no contraindication for surgery or contraindication for TAVI access routes, the decision is based on the patient’s comorbidities and life expectancy. In patients over 80 years old, with a life expectancy of less than 10 years, TAVI is recommended. In patients over 90 years old, the decision on the use of TAVI is strongly associated to life expectancy and quality of life. State funders from high-income countries cover TAVI in inoperable patients. Some private US funders extend this coverage to high-risk patients. In Latin America, Argentina includes this technology in the Unique Reimbursement System (Sistema Único de Reintegro) for inoperable and high-risk patients, as well as Brazil. Its use is not considered in Uruguay, Chile or Colombia. In Argentina, the cost-effectiveness of this procedures is unknown. The Budget impact estimated by Argentina’s National Committee of Health Technologies (CONETEC) is high. Those countries where funders cover this technology, mention that there should be a price agreement.
Details
Project Status: Completed
Year Published: 2021
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Aortic Valve Stenosis
  • Transcatheter Aortic Valve Replacement
  • Aortic Valve
  • Heart Valve Prosthesis Implantation
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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