Transcatheter Aortic Valve Implantation for Treatment of Aortic Valve Stenosis: A Health Technology Assessment

 The aortic valve is one of four valves in the heart. It allows blood to flow from the left ventricle of the heart into the aorta (the main artery in the body). Aortic valve stenosis occurs if the valve narrows and cannot open all the way, partially blocking the flow of blood out of the heart. Severe aortic valve stenosis can lead to death, usually from heart failure. 

The diseased aortic valve can be removed and replaced with an artificial valve, but doing this involves open-heart surgery. Transcatheter aortic valve implantation, or TAVI, is a newer procedure. In most cases, cardiologists make a small opening in an artery near the groin to insert a catheter to deliver and implant the new valve. 

In this assessment is reviewed the research that compared TAVI with surgical aortic valve replacement. TAVI and surgery had similar rates of death, and both improved patients’ quality of life in the first year. TAVI was associated with higher risk of stroke, major vascular complications, leakage of blood around the valve (aortic regurgitation), and the need for a pacemaker. Surgical aortic valve replacement was associated with a higher risk of bleeding. Another treatment option for people who cannot have surgical valve replacement involves using a balloon to open the blocked valve. People who had TAVI lived longer than people who had the balloon procedure. We also reviewed the economic evidence and developed an economic model to explore the cost-effectiveness of TAVI. We found that TAVI provided reasonably good value for money when compared with surgical aortic valve replacement.