As we have explained on “What does TAVI mean? What is it for?”, the election of the most proper technique for treating aortic stenosis on a patient must be done on an individual basis, considering the specific factors for each person.
Regardless of that, evaluating it as TAVI application is interesting as it has been evolving over the years and it will probably evolve in the coming years.
The first stage: inoperable patients
The first transcatheter aortic valve was implanted in France, in 2002, as the culmination of the previous years work.
In that first stage, this technique was oriented to patients with severe aortic stenosis that could not be treated with conventional techniques (thorax aperture, non-heart-beating, circulation, extracorporeal…) as they show other risk factors (age, associated diseases, etc.) that made the standard valve substitution unacceptable. It is known as “inoperable patients”.
After several cases, it was observed that the results were not lower than those on the conventional surgery, so its use was increasingly extended.
High risk – intermediate risk – low risk
After treating patients at higher surgical risk with this technique, the results of treating transcatheter aortic valve implantations (TAVI) to patients who showed an even lower surgical risk were increasingly analysed. In the first place, high risk patients, then intermediate risk and finally low risk patients were susceptible to be performed this technique, all of this agreed with multicentre clinical studies.
So, who has to be implanted a transcatheter aortic valve or TAVI?
After analysing that information (first on the high risk patients and then on low risk patients), the conclusion on this technique is similar to the approach of the rest of techniques: it is important to individualise each case and to choose the best option for each patient, paying attention not only to the main disease (aortic stenosis) but the context (age, general health, associated disease, expected difficulties during the recovery, etc.)
In many occasions, this decision is made jointly in heart multidisciplinary teams (which is named “heart team”) where different specialists exchange their points of view, and they reach an evaluation by consensus.