Recommendation for NHSScotland
The evidence reviewed offers support for the provision of TAVI for adults with aortic stenosis (AS) who are deemed to be at high surgical risk, although it is worth noting the uncertainty surrounding the generalisability of the trial participants’ risk scores to clinical practice in Scotland. Compared with surgical AVR, TAVI was found to be clinically effective and cost effective.
The evidence review identified a number of ongoing RCTs comparing TAVI with surgical AVR using other devices in a range of patient risk categories that could provide important evidence in the future.
NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.
What were we asked to look at?
Is Transcatheter aortic valve implantation (TAVI) clinically and cost effective for severe symptomatic aortic stenosis in adults at high surgical risk?
Why is this important?
TAVI is an alternative to conventional surgical aortic valve replacement (AVR) for operable patients with severe symptomatic aortic stenosis (AS) at high risk for surgical
complications. A Scottish national TAVI service was established in September 2012 in a single centre at the Royal Infirmary of Edinburgh, offering TAVI only to patients deemed not suitable for conventional AVR surgery.
The population prevalence of patients likely to benefit sufficiently from TAVI has yet to be established. 120-140 TAVI procedures are carried out each year in Edinburgh, 75% via transfemoral route, 15% direct aortic route and 10% transapical route. In total, combining individuals with aortic stenosis who are unsuitable for surgery and those at high surgical risk, it is estimated that between 90 to 390 patients per year in Scotland could be eligible for TAVI.
National Planning Forum TAVI Review Group