Aortic stenosis - shortening the learning curve for transcatheter valve implantation

Outcomes for transcatheter valve implantation (TAVI) are often related to patient selection. TAVI is a relatively new alternative for patients with aortic stenosis (AS) who are at excessive risk for conventional aortic valve replacement (AVR) by surgery.>

During yesterday′s session, the panel explored the need for well-conducted clinical trials stressing the importance of education for treating AS with TAVI. Olaf Wendler discussed state-of-the-art surgical techniques for AVR and said that AS is one of the most common aortic problems. Good knowledge of devices is necessary to avoid patient prosthesis mismatch.

Three case demonstrations were elegantly and successfully conducted. The first was a Live in-a-box^TM presentation showcasing the educational value of this tool. The second case demonstration resulted in animated discussion as the procedural indication was questioned by the panel. This reminds us that adoption of this technique should not be rushed for the protection of the patients and to also maintain the scientific rigour that will place this new technique in the frontline of clinical practice.

Interestingly, GT Stavridis highlighted this philosophy in his presentation immediately following the live case, saying that we should recruit patients for TAVI using well thought out reasoning and inclusion/exclusion criteria.

Hélène Eltchaninoff and John Webb discussed the requirements for setting up a TAVI programme, saying that experience of treating valvular disease is crucial. The session was summarised by Philipp Bonhoeffer who said, we know that TAVI is already being used for treating aortic stenosis but should remember that AVR remains the gold standard for suitable patients and that careful, rigorous, controlled use of TAVI along with good education and clinical trials are needed for TAVI to be accepted by the wider community.