ÎÎPatient 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.
ÎÎRegistries 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.
ÎÎEarly 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.
Requisite pieces of information to screen for TAVR include:
ÎÎData sufficient to calculate Society of Thoracic Surgeons (STS) score
ÎÎMeasurement of clinical parameters related to the presence of
comorbid conditions such as pulmonary function tests in patients with
chronic obstructive pulmonary disease (COPD)
ÎÎAssessment for the degree of cognitive impairment as appropriate
ÎÎImaging 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
ÎÎPreprocedural 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
