New AHA/ACC guidance released for TAVI

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A new expert consensus decision pathway will assist clinicians and hospitals in assessing patients’ eligibility for transcatheter aortic valve implantation (TAVI), performing the procedure successfully and providing appropriate follow-up. The “2017 American College of Cardiology (ACC) Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis” builds on recommendations set forth in the “2014 American Heart Association (AHA)/ACC Guidelines for Management of Patients with Valvular Heart Disease”, and was published the Journal of the American College of Cardiology.

Chaired by Catherine M Otto, researchers developed checklists that serve as a starting point for managing patients who are being considered for TAVI. The document also takes clinicians through the steps that are needed to successfully perform the procedure, including what imaging tests are needed and how to ensure continuity of care when patients transition back to their treating physicians.

The document provides a framework with four key sets of considerations: (1) pre-procedure considerations, (2) which imaging tests and measurements are needed and when, (3) key issues and considerations in performing the TAVI procedure itself and managing complications, and (4) managing patients immediately after the procedure and for longer follow-up to ensure continuity of care.

The new checklists help clinicians apply best practices, including determining if TAVI is appropriate in the context of individual patient considerations. The guidance also reinforces the central role of the heart valve team and the need for close collaboration with other clinicians, who should ideally have easy access to care plans, including what imaging tests are needed. The writing committee hopes hospitals and valve centres will expand upon these resources to create their own internal checklists to use in patient care and update them over time to reflect the most recent clinical recommendations.

“TAVI is one of the most rapidly expanding technologies in medical care today, and as our population ages, we will see increasing numbers of people with severe aortic valve stenosis, so it is important to provide guidance on optimal use of this treatment,” Otto says. “There is also a great deal of interest among patients who usually prefer TAVI over open heart valve surgery, if this option is appropriate for their medical condition.”