The 2020 American College of Cardiology/ American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease. Should the World Jump In?

The official position of the Latin American Association of Cardiac and Endovascular Surgery (LACES) regarding the recently released SOLACI/ SIAC Clinical Guidelines on TAVI versus SAVR

“…The SOLACI/SIAC document implicitly assumes an equipoise between long-term outcomes of TAVI and SAVR, which has been challenged by recent evidence. In this way, the results of randomized controlled trials, metanalyses, and national databases show the opposite ( 6 ) . The report of the five-year outcomes of the Placement of Aortic Transcatheter Valve (PARTNER) 2 cohort A trial found a higher risk of death or disabling stroke between two and five years after TAVI than after SAVR, with a hazard 27% higher ( 7 ) , ( 8 ) .…”

The trade‐offs in the making of the interventional heart surgeon

“…For now, only the surgical aortic valve replacement (SAVR) is established to restore the prognosis of patients with symptomatic severe AS with long-term postoperative survival becoming comparable to an age-and sexmatched general population without AS in patients over 65-year old. 2 The enthusiasm with TAVI derived from an assumed equipoise between long-term outcomes of TAVI and SAVR, which has been challenged by a crescendo body of evidence for higher long-term mortality and complications associated with TAVI, according to randomized controlled trials (RCT), meta-analysis, and national databases. In this way, the report of the 5-year outcomes of PARTNER 2 cohort A trial found a higher risk of death or disabling stroke between 2 and 5 years after TAVI than after SAVR, with a hazard 27% higher.…”

“…In times of extreme pressure on health resources, regardless of the countries' economic position, adopting a new technology that is 5-10 times more expensive than the existing standard, with inferior results, seems illogical and requires serious reflection. 2 Moving forward, transcatheter edge-to-edge repair is no better than meds as shown in a reputable trial, 14 despite another controversial and secretive trial pointing otherwise, 15 and this lack of transparency strengthens distrust. 16 The case for endovascular aneurysm repair (EVAR) should be emblematic for cardiovascular surgeons and serve as a lesson.…”

“…Oddly, these crucial data are not making headlines, relegated to footnotes, and dangerously obscured from the medical community. 2,12,13 The trade-off between the less invasive with early hospital discharge, but the higher cost and lower long-term survival with TAVI, and the need for sternotomy and longer hospital stay, but with lower cost and longer survival with SAVR should be an integral part of the Heart Team discussion and the tailored recommendation for individual patients, many of whom fall outside the RCT inclusion criteria.…”

“…A growing concern is the economic impact of expanding recommendations elsewhere, where countries with inadequate healthcare budgets and expenditure comprise a far different setting. In times of extreme pressure on health resources, regardless of the countries' economic position, adopting a new technology that is 5–10 times more expensive than the existing standard, with inferior results, seems illogical and requires serious reflection 2 …”