title: High Risk Aortic Valve Replacement - The Challenges of Multiple Treatment Strategies with an Evolving Technology.
abstract: OBJECTIVE
  Deciding on the optimal treatment strategy for high risk aortic valve replacement is challenging. Transcatheter Aortic Valve implantation (TAVI) has been available in our centre as an alternative treatment modality for patients since 2008. We present our early experience of TAVI and SAVR (surgical Aortic Valve Replacement) in high risk patients who required SAVR because TAVI could not be performed.
  
  
  METHODS
  The database for Surgical aortic valve and Transcatheter aortic valve replacement referrals was interrogated to identify relevant patients.
  
  
  RESULTS
  Survival to hospital discharge was 95.5% in the forty five patients who had SAVR when TAVI was deemed technically unsuitable. One year survival was 86%.
  
  
  CONCLUSIONS
  Defining who is appropriate for TAVI or high risk SAVR is challenging and multidisciplinary team discussion has never been more prudent in this field of evolving technology with ever decreasing risks of surgery. The introduction of TAVI at our institution has seen a rise in our surgical caseload by approximately by 25%. Overall, the option of aortic valve intervention is being offered to more patients in general which is a substantial benefit in the treatment of aortic valve disease.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.
authors.forename: K
authors.initials: K
authors.lastname: Booth
authors.affiliation: Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.
authors.forename: R
authors.initials: R
authors.lastname: Beattie
authors.affiliation: Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.
authors.forename: M
authors.initials: M
authors.lastname: McBride
authors.affiliation: Department of Cardiology, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.
authors.forename: G
authors.initials: G
authors.lastname: Manoharan
authors.affiliation: Department of Cardiology, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.
authors.forename: M
authors.initials: M
authors.lastname: Spence
authors.affiliation: Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA.
authors.forename: J M
authors.initials: JM
authors.lastname: Jones
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
keywords: Conventional Aortic Valve Replacement (AVR); High risk conventional Aortic Valve Replacement; Transcatheter Aortic Valve Implantation (TAVI)