title: Is TAVI superior to surgery in high-risk patients? Insight into the concept of individual risk assessment.
abstract: The prevalence of aortic valve stenosis (AS) is growing in developed countries because its prevalence increases with age. A growing number of elderly patients are currently referred to specialized centres to be evaluated for potential therapeutic strategies. Indeed, two techniques are nowadays able to treat high-risk AS patients: TAVI and surgical replacement (AVR). It is the purpose of the present review to summarize current knowledge on safety and efficacy of AVR and TAVI in high-risk patients; to focus on some aspects of recently published guidelines; to emphasize the growing importance of pre-operative individual risk assessment, which is considered the real crucial point for patient selection and trial's comparisons. Indeed, it is worth of noting that currently adopted risk-scores do not show satisfactory performances. Accordingly, it becomes of utmost importance to investigate several baseline but still neglected patients' characteristics (e.g. frailty, functional status, co-morbid conditions, etc.), as well as their pathogenetic relationships with interventional results and follow-up prognosis. All these items are emphasized in the present review. Finally, we have tried to anticipate future scenarios in terms of both ongoing clinical trials and improvements of risk-scores.
authors.affiliation: Division of Cardiology, University of Verona Medical School, Verona, Italy - francesco.onorati@ospedaleuniverona.it.
authors.forename: G
authors.initials: G
authors.lastname: Benfari
authors.forename: F
authors.initials: F
authors.lastname: Onorati
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.forename: R
authors.initials: R
authors.lastname: Abbasciano
authors.forename: C
authors.initials: C
authors.lastname: Zivelonghi
authors.forename: A
authors.initials: A
authors.lastname: Salsano
authors.forename: F
authors.initials: F
authors.lastname: Ribichini
authors.forename: F
authors.initials: F
authors.lastname: Santini
authors.forename: F
authors.initials: F
authors.lastname: Vassanelli
authors.forename: A
authors.initials: A
authors.lastname: Mazzucco
authors.forename: G
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D005500:Follow-Up Studies; D016330:Frail Elderly; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D015337:Multicenter Studies as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012306:Risk; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis; D063189:Symptom Assessment; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome