Interv Akut Kardiol. 2023;22(4):194-200 | DOI: 10.36290/kar.2023.028

TAVI: when not anymore?

Hana Línková

Kardiologická klinika, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha

Transcatheter aortic valve implantation (TAVI) has caused a significant change in the treatment of aortic stenosis. It has expanded treatment to include patients not previously indicated for surgical intervention. Despite the tremendous benefit of this method, there are patients who do not benefit from treatment and in whom TAVI is considered unnecessary. In pivotal studies of high-risk patients, one-third either died, or their quality of life failed to improve and their symptoms persisted. The futility of TAVI in such patients thus leads to their unnecessary exposure to risk. Factors that lead to poor outcomes after TAVI and increase the risk of death despite successful implantation include patient frailty and certain cardiac and non-cardiac diseases. These comorbidities may prevent improvement in symptoms and quality of life. On the other hand, some comorbidities may be reversible after the TAVI procedure. This article provides an overview of the main associated comorbidities that may contribute to poor outcomes, identifying reversible factors and looking at frailty assessment. The latter is crucial for TAVI futility. The paper also highlights the need for a systematic approach to patient assessment so that the potential futility of TAVI could be assessed more accurately and comprehensively.

Keywords: transcatheter aortic valve implantation, aortic stenosis, futility, frailty, risk stratification.

Received: March 30, 2023; Revised: October 11, 2023; Accepted: October 24, 2023; Published: November 28, 2023  Show citation