title: [Which indications and access routes for transcatheter aortic valve implantation? Health technology assessment from HAS].
abstract: The transcatheter aortic valve implantation should be restricted to patients with severe symptomatic aortic stenosis with a contraindication for a surgical replacement (taking into account surgical risk scores, comorbidities, anatomical conditions, life expectancy and frailty). Patient eligibility should be performed by a heart team with the involvement of a cardiac surgeon, an interventional cardiologist, a clinical cardiologist and an anaesthetist/resuscitation specialist. The advice of a geriatrician is strongly recommended. The long-term efficacy remains unknown. The French National Authority for Health (Haute Autorité de santé [HAS]) reminds that contraindications in the CE mark should be strictly respected (i.e.instructions for use). Extension of current indications should be conditional to the presentation of clinical evidence. Thus, implantation in patients at lower surgical risk or the use of direct transaortic route are not eligible for reimbursement given the current state of knowledge.
authors.affiliation: Haute Autorité de santé, 93218 Saint-Denis-La-Plaine cedex, France. e.velzenberger@has-sante.fr
authors.forename: Elodie
authors.initials: E
authors.lastname: Velzenberger
authors.forename: Hubert
authors.initials: H
authors.lastname: Galmiche
authors.forename: Catherine
authors.initials: C
authors.lastname: Denis
authors.forename: Jacques
authors.initials: J
authors.lastname: Machecourt
mesh_terms: D001021:Aortic Valve / Q000601:surgery / Q000637:transplantation; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D020811:Biomedical Technology / Q000379:methods / Q000639:trends; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005602:France; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome