Lack of definite indication criteria for choosing between transcatheter implantation and surgical replacement of the aortic valve

Abstract

Age and logistic Euroscore might be inadequate criteria for the identification of patients with severe aortic stenosis unsuitable for AVR and addressable to TAVI.

Patient selection for cardiac surgery: Time to consider subgroups within risk categories?

“…1, middle box). Nevertheless, there is an ongoing discussion on whether risk stratification is appropriate and sufficient in allocating patients to TAVI instead of (surgical) AVR [10][11][12][13].The differences in combinations of risk factors present in high-risk patients (Table 1), as well as subgroup analyses of TAVI outcomes and sensitivity analyses in economic evaluations of TAVI age [17,18,29], suggest that benefits and risks, as well as costs, may vary substantially between subgroups within the high-risk category. This indicates that providing either all or none of the high-risk patients with TAVI is both unlikely to be optimal.…”

“…Next, we performed cluster analysis to identify subgroups among patients within the high-risk category. As age is oftentimes an important factor in both effectiveness and occurrence of complications of treatment [13], we identified subgroups separately among high-risk patients younger than 75 years of age, and patients aged 75 or older.…”

“…1, middle box). [7][8][9], there is an ongoing discussion on whether this is appropriate and sufficient in allocating patients to TAVI instead of (surgical) AVR [10][11][12][13]. Patients would ideally be selected for TAVI or SAVR after discussion by a multidisciplinary heart team [14,15].…”