The SURTAVI model: proposal for a pragmatic risk  stratification for patients with severe aortic stenosis.
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis (AS) and a high operative risk. Risk stratification plays a decisive role in the optimal selection of therapeutic strategies for AS patients. The accuracy of contemporary surgical risk algorithms for AS patients has spurred considerable debate especially in the higher risk patient population. Future trials will explore TAVI in patients at intermediate operative risk. During the design of the SURgical replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial, a novel concept of risk stratification was proposed based upon age in combination with a fixed number of predefined risk factors, which are relatively prevalent, easy to capture and with a reasonable impact on operative mortality. Retrospective application of this algorithm to a contemporary academic practice dealing with clinically significant AS patients allocates about one-fourth of these patients as being at intermediate operative risk. Further testing is required for validation of this new paradigm in risk stratification. Finally, the Heart Team, consisting of at least an interventional cardiologist and cardiothoracic surgeon, should have the decisive role in determining whether a patient could be treated with TAVI or SAVR.
Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. n.vanmieghem@erasmusmc.nl
Nicolas M
NM
van Mieghem
Stuart J
SJ
Head
Robert M A
RM
van der Boon
Nicolo
N
Piazza
Peter P
PP
de Jaegere
Thierry
T
Carrel
A Pieter
AP
Kappetein
Ruediger
R
Lange
Thomas
T
Walther
Stephan
S
Windecker
Gerrit-Anne
GA
van Es
Patrick W
PW
Serruys
D000465:Algorithms; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002986:Clinical Trials as Topic; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D012307:Risk Factors