Transcatheter Aortic Valve Replacement

Percutaneous aortic valve replacement
Intervention
ICD-9-CM	35.05
[]

Percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). The replacement valve is delivered via one of several access methods: transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta), and transcaval (from a temporary hole in the aorta near the belly button through a vein in the upper leg).

Severe symptomatic aortic stenosis carries a poor prognosis. Until recently, surgical aortic valve replacement has been the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure or coronary artery disease, as well as in people with comorbidities such as cerebrovascular and peripheral arterial disease, chronic kidney disease, and chronic respiratory dysfunction.

A systematic review of low and intermediate risk people showed that transfemoral TAVR probably reduces short-term risk of death, stroke, life-threatening bleeding, but increases the risk of heart failure symptoms and slightly increases the need for a reintervention. The same review found credible evidence that transapical TAVR probably increases the risk of death, stroke, acute kidney injury, pacemaker insertion, and slightly increased need for reintervention compared to surgical aortic valve replacement. Longterm TAVR valve durability >5 years remains unknown, especially relevant to patients with a longer life expectancy.

Transapical TAVR should only be used in extreme circumstances: an evidence-based BMJ Rapid Recommendation made a strong recommendation against transapical TAVR in people who are also candidates for either transfemoral TAVR or surgery. People who have the option of either transfemoral TAVR or surgical replacement are likely to choose surgery if they are younger than 75 and transfemoral TAVR if they are older than 75. The rationale for age-based recommendations is that surgical aortic valve replacements are known to be durable long-term (average of durability of 20 years) so people with longer life expectancy would be at higher risk if TAVR durability is worse than surgery.

...
Wikipedia