Aortic stenosis is the most common form of valvular heart disease in the western world and predominantly affects older patients. In this condition, narrowing and calcification of the aortic valve causes obstruction to the outflow of blood from the heart. When severe, this causes symptoms such as chest pain, breathlessness and fainting, and it can lead to heart failure and death if untreated. Current standard treatment involves opening the chest to perform surgical aortic valve replacement (AVR) with cardiopulmonary bypass. However, a newer approach, Transcatheter Aortic Valve Implantation (TAVI), now offers a much less invasive alternative. First used in humans in 2002, it is now commonly used in patients who are not fit enough or otherwise unsuitable for surgical AVR. TAVI is usually performed under sedation or local anaesthesia rather than general anaesthesia in a catheterization laboratory (or ‘cath lab’) rather than an operating theatre. During the procedure, the folded artificial valve is delivered to the heart using a catheter and guide wire passed through the arteries, which are usually accessed via the groin. Once in place, the valve is then opened up, pushing the old valve aside and sitting snugly in place within the heart.
The UK TAVI trial explored the use of Transcatheter Aortic Valve Implantation (TAVI) in patients who are at lower risk than those in whom the procedure is currently used. Participants were required to be 70 years of age or over, with an additional risk factor (e.g. diabetes, kidney problems or previous heart surgery) and therefore considered to be at intermediate or high risk for surgical AVR. If aged 80 or over, age alone would qualify the patient for inclusion. All patients had to be suitable for both TAVI and surgical AVR with eligibility determined by a multi-disciplinary team, including surgeons, interventional cardiologists, experts in cardiac imaging and others. Once consent had been given, the patient was randomly assigned to receive either TAVI or surgical AVR. Patients were then followed up for five years, with clinical review and questionnaires to assess quality of life and functional improvement.
Royal Papworth Hospital were the highest recruiting centre and after a massive team effort, they have just completed the last 5 year follow ups. A special thanks goes to Rebecca Hussey who has worked on the study right from the beginning and Suzy Deeley who helped complete the follow ups and data clean up.”