2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation

Abstract

Transcatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at intermediate surgical risk. Recent clinical trial data have shown the benefits of this technology in patients at low surgical risk as well. This update of the 2012 R ESUM E L'implantation valvulaire aortique par cath eter (TAVI) a rapidement modifi e le traitement des patients atteints de st enose aortique symptomatique grave. Elle constitue maintenant la norme de soins chez les patients jug es inop erables ou pr esentant un risque chirurgical elev e, de même qu'une solution de rechange raisonnable à la chirurgie de remplacement valvulaire aortique en pr esence d'un risque chirurgical interm ediaire. Les donn ees d'essais cliniques r ecents ont aussi Aortic stenosis (AS) is the most common valvular heart disease in elderly patients, with increasing prevalence worldwide. 1 Initially considered experimental, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has transitioned rapidly to the standard of care for inoperable patients with symptomatic severe AS and those at high surgical risk. 2 In 2012, the Canadian Cardiovascular Society (CCS) published its first position statement for TAVI. 3 This update is on the basis of new evidence that has become available since 2012, with the goal of providing guidance to Canadian programs in which patients with severe AS are treated and to address the unique challenges they face in terms of access to care, funding for interventions, infrastructure availability for program management and data collection, and support for patient preference in therapeutic decision-making. Methods This document was developed in accordance with CCS best practices and in accordance with the Framework for Application of Grading of Recommendations, Assessment, Development, and Evaluation (see https://www.ccs.ca/ images/Development_Process/CCS_GRADE_Framework_ June2015.pdf for details). A systematic review of the literature was performed to evaluate TAVI program considerations, patient selection, and procedural and postprocedure guidelines. The primary panel voted on all recommendations and acceptance was defined as agreement of two-thirds of the

Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes

“…The pivotal role of the TAVI programme nurse who leads the coordination of patients' journey of care is made all the more salient in current times. Although well established in some regions, and endorsed in multiple guidelines as an important member of the multidisciplinary team, 13,14 this role remains in its infancy or is absent across most of Europe. The competencies of this expert clinician include knowledge of the aortic stenosis patient population, their clinical presentation and disease progression, clinical assessment of symptoms and urgency, patient and family education to facilitate shared decision-making and early discharge planning, and the coordination of complex, and currently altered, processes of care.…”

Single- or dual-antiplatelet therapy after transcatheter aortic valve replacement

“…Despite the lack of evidence, the American guidelines and Canadian statement suggest aspirin indefinitely and clopidogrel for a specific time period. [ 24 , 25 ]…”

Restricted mean survival time of older adults with severe aortic stenosis referred for transcatheter aortic valve replacement

“…Those that typically do not benefit have severe frailty as defined by an EFT score of 5/5, advanced dementia, bedbound or non-mobile status, cachexia or severe sarcopenia, or disability for most basic activities of daily living. These risk factors, coupled with the aforementioned end-stage kidney, lung, and liver disease, have been grouped in the A-B-C-D-E mnemonic, which was put forth in the 2019 Canadian Cardiovascular Society TAVR Consensus Statement to guide decision making in potentially futile cases [18].…”