Patients with symptomatic severe aortic stenosis have a mortality rate of approximately 50% at 2 years without intervention. In patients who are deemed too high risk for open heart surgery, TAVR significantly reduces the rates of death and cardiac symptoms. TAVR was not routinely recommended for low risk patients in favor of surgical aortic valve replacement, however it is increasingly being offered to intermediate risk patients, based on recent studies showing it to be non-inferior to surgical aortic valve replacement. Transapical TAVR is reserved for patients for whom other approaches are not feasible: 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.
Percutaneous aortic valve replacement
Mitral valve repair
Aortic valve repair
Mitral valve replacement
Aortic valvuloplasty
Percutaneous pulmonary valve implantation
Mitral valve annuloplasty
Aortic valve replacement