title: Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis: Is It Justified to Be the Preferred Treatment?
abstract: Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients' risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
authors.affiliation: From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.).
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdelghani
authors.affiliation: From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.). patrick.w.j.c.serruys@gmail.com.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000401:mortality; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D018579:Patient Selection; D011183:Postoperative Complications; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: aortic valve stenosis; heart valve prosthesis implantation; risk assessment; transcatheter aortic valve replacement