Abstract
Background Transcatheter aortic valve implantation (TAVI) is a new treatment option for patients
with severe symptomatic aortic stenosis. Despite a lack of scientific evidence for
a benefit of the procedure compared with surgical valve replacement or repair as the
current gold standard and pending questions about safety and long-term results, a
continuous and remarkable increase of its application in Germany can be observed.
Methods In a systematic research, publications suitable for the deduction of criteria for
indication and structural and process standards were identified.
Results No appropriate studies exist to define scientifically sound criteria for indication
and structural and process standards for TAVI. Two randomized controlled trials give
hints for potential patient selection criteria. However, several interdisciplinary
position statements of the most relevant scientific societies in Europe and North
America provide recommendations for indication criteria and minimum structural and
process requirements. TAVI should be used only in patients with contraindications
for open surgery or highest perioperative risk. Multidisciplinary heart teams comprising
at least one cardiac surgeon and one cardiologist are mandatory for patient selection
and performance of TAVI. Structural equipment to carry out immediate open heart surgery
is mandatory. Most recommendations require performing TAVI only in hospitals with
a cardiac surgery unit. Participation in a registry is recommended.
Conclusion Currently, TAVI should be restricted to patients with severe symptomatic aortic valve
stenosis and contraindications against open heart surgery or maximum perioperative
risk. The surgical risk should be assessed by a multidisciplinary team. The procedure
should be performed by interdisciplinary heart teams in hospitals with a cardiac surgery
unit.
Keywords
transcatheter aortic valve implantation - TAVI - indication - structural and process
requirements
