Transcatheter valve implantation in patients with aortic stenosis – current results and future needs

To commence, Patrick Serruys discussed a matching study of patients receiving TAVI (n=114) or surgical AVR (n=1008), identifying 2 groups with overlapping baseline characteristics for which the 30-day mortality was 9.6% against 2.3% respectively. However, after employing statistical risk adjustment techniques, the conclusions to be drawn here are limited. TAVI could be associated with either substantial benefits or harm and a randomised comparison is required.

Mirko Doss reviewed the results from 4 multicentre studies in which patients received transapical TAVI. The 30-day survival figures were summarised for the TRAVERSE Trial (92%), REVIVAL II (92.7%), PARTNER EU (85.9%) and The SOURCE Registry (89.6%). He concluded that transapical TAVI is safe and effective, and provides excellent valve performance.

Frans Oei discussed subclavian artery access as being relatively free from atherosclerosis, less tortuous, providing more direct access and not requiring thoracotomy. The 30-day mortality in 74 patients (CoreValve database) treated by transaxillary TAVI was 14.9% and he proposed that this approach is technically feasible and safe. This was well demonstrated by video.

Carlos Ruiz presented an update of the rapidly evolving technologies and from an ethical viewpoint, Thomas Luscher emphasised the importance of informed consent, and the interdisciplinary approach in achieving appropriate randomisation.

Live in-a-box™ cases beautifully demonstrated a transapical and transfemoral TAVI, with interactive discussion led by Alain Cribier.

The session was summarised by Didier De Cannière. Surgical AVR remains the gold standard. TAVI is a valid alternative treatment for selected, usually high risk subsets of patients. Based on intention to treat, surgical and TAVI patients have different risk profiles, making cohorts difficult to compare.

Therefore RCTs are warranted. EuroSCORE overestimates surgical mortality after AVR and alternative risk scorings are needed. TAVI has provoked a deep reengineering of decision- making in invasive cardiology, central to which is the "Heart Team"; we should now "confidently" wait for long-term trial results.