Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline

A randomised controlled trial of transcatheter aortic valve
insertion (TAVI) versus surgical aortic valve replacement
(SAVR) in patients with severe aortic stenosis was published
in April 2016. The Partner 2 trial included 2032 people at
intermediate surgical risk and favoured TAVI over open SAVR
at two years for some outcomes.1 It had the potential to change
practice.
Before the availability of TAVI, the only effective treatment
for symptomatic severe aortic stenosis was SAVR with
mechanical or bioprosthetic valves (fig 1⇓). In practice, patients
offered mechanical valves tend to be younger and must accept
lifelong anticoagulation. The minimally invasive option, TAVI,
was developed for patients who are unfit for surgery, in whom
its use is recommended by major US and European guidelines.2 3
Severe aortic stenosis affects approximately 3 in 100 people
over the age of 75 years.4 Patients typically experience
symptoms of heart failure and reduced quality of life. Without
aortic valve replacement, life expectancy is typically 50% at
two years, with escalation of heart failure and reduced quality
of life.5 These recommendations are for patients with symptoms
and severe aortic stenosis: patients without symptoms or with
milder disease are not considered here.