Treatment
����Participation in national TAVR registries is recommended.
Requisite pieces of information to screen for TAVR include:
����At the present time, the most data available for TAVR are based upon 2
specific devices (see J Am Coll Cardiol. 2012;59(13):1200-54. PMID:
22300974 for details).
����Data sufficient to calculate Society of Thoracic Surgeons (STS) score
����Patient selection criteria in trials (details in Holmes DR et al. J Am Coll
Cardiol. 2012;59(13):1200-54.):
������ Symptomatic native tricuspid aortic valve stenosis deemed operable by multiple
factors.
������ Risk outweighs benefit from surgical AVR.
������ Benefit outweighs risk from TAVR.
����Registries to date demonstrate that TAVR in high-risk patients may
be deployed with a high degree of procedural success, predictable
risk of stroke, device-dependent high risk of pacemaker implantation
(particularly with CoreValve), and a 30-day mortality rate acceptable in
severely debilitated and ill patient populations.
Importantly, TAVR seems to alleviate AS to a similar degree as surgical AVR, and
patients tend to return to Class I or II symptoms with substantial improvements in
quality of life.
����Early mortality ranges from an in-hospital rate of 5%-8% and a 30-day
mortality rate from 8%-10%. Other complications vary and include
stroke, vascular access injury, and pacemaker implantation.
����Measurement of clinical parameters related to the presence of
comorbid conditions such as pulmonary function tests in patients with
chronic obstructive pulmonary disease (COPD)
����Assessment for the degree of cognitive impairment as appropriate
����Imaging data to confirm
������ Presence and severity of tricuspid aortic stenosis
������ Presence and severity of associated CAD
������ Left ventricular function
������ Presence and severity of associated valvular heart disease lesions
������ Presence and extent of cerebral vascular disease
����Preprocedural imaging for planning should be done by the institution
performing TAVR
������ Assessment of annular size for device selection
������ Assessment of details of arterial anatomy including the peripheral aortoiliac vessels as
well as the aortic arch and ascending aorta, which may influence access selection
