From the Guidelines
In Australia, the volume of Transcatheter Aortic Valve Replacement (TAVR) procedures is surpassing Surgical Aortic Valve Replacement (SAVR) volumes, with TAVR being the preferred option for patients over 65 years old or those with high surgical risk, as indicated by the 2020 ACC/AHA guideline for the management of patients with valvular heart disease 1. The shift towards TAVR is driven by its less invasive nature, improved device technology, and favorable outcomes in appropriate patients. According to the guideline, TAVR is recommended for patients with symptomatic severe aortic stenosis who are at high or prohibitive surgical risk, or those with a life expectancy of more than 1 year with acceptable quality of life 1. Key factors influencing the choice between TAVR and SAVR include:
- Patient age and life expectancy
- Surgical risk assessment, including STS score and frailty measures
- Valve and vascular anatomy suitability for TAVR
- Patient preferences and values
- Presence of concomitant cardiac conditions requiring surgical intervention As the Australian healthcare system continues to adapt to this evolving treatment landscape, reimbursement policies are being updated to accommodate the increasing use of TAVR. The guideline emphasizes the importance of shared decision-making between patients, heart valve teams, and clinicians to determine the most suitable treatment approach for each individual case 1.
From the Research
Comparison of TAVR and SAVR Volumes in Australia
There are no research papers provided that directly compare the volumes of Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement (SAVR) in Australia.
Available Evidence on TAVR and SAVR
- The provided studies focus on the outcomes and comparisons of TAVR and SAVR in different patient populations, but do not provide data on the volumes of these procedures in Australia 2, 3, 4, 5, 6.
- Studies have compared the outcomes of TAVR and SAVR in patients with severe aortic stenosis, including those at low risk for surgery 5.
- Research has also investigated the use of TAVR and balloon aortic valvuloplasty in patients with severe aortic stenosis and cardiogenic shock 6.
- A systematic review and meta-analysis compared the benefits and harms of TAVI, SAVR, medical therapy, and balloon aortic valvuloplasty in patients with aortic valve stenosis 4.
Key Findings
- TAVR has been shown to be a viable alternative to SAVR in patients with severe aortic stenosis, with similar mortality rates and different patterns of adverse events 4.
- TAVR has been associated with lower rates of major bleeding, but higher rates of major vascular complications and paravalvular regurgitation compared to SAVR 4.
- In patients with severe aortic stenosis and cardiogenic shock, TAVR may be a better strategy than balloon aortic valvuloplasty, with fewer primary outcome events and lower mortality rates 6.