The National Institute for Health and Clinical Excellence (NICE) has updated its guidance for the NHS on a procedure which avoids open heart surgery to replace a diseased heart valve.
This guidance could benefit people who have aortic stenosis – a potentially fatal condition in which the aortic valve becomes narrowed, making blood flow more difficult. The procedure, called transcatheter aortic valve implantation (TAVI), involves replacing the narrowed aortic valve with an artificial one, which is inserted into the patient’s heart through a catheter. This is an alternative to open-heart surgery (surgical aortic valve replacement, SAVR) in which the aortic valve is replaced by opening up the chest. The guidance updates and replaces previous guidance from 2008. The main updates are recommendations on the use of TAVI for people who would be considered unsuitable for openheart surgery and on when to consider TAVI as an option for people who could have the more invasive option instead. NICE did not advise on the use of TAVI for these patient groups in 2008 because there was insufficient evidence at the time. Commenting on the latest guidance, Professor Bruce Campbell, chair of the independent committee that develops NICE’s interventional procedures guidance said: “Current evidence on the safety of TAVI for aortic stenosis shows there are serious but wellrecognised complications associated with it. Considering TAVI as a treatment option means balancing these issues against the risk of serious complications if the patients were to have the open-heart surgery to replace their narrowed aortic valves. Possible benefits of TAVI could include fewer complications for patients who are at high risk from open-heart surgery, quicker recovery and fewer readmissions to hospital. TAVI seems to work well in the short term, with good results for patients during the first year. “However, NICE recognises that TAVI is a technically challenging procedure and so advises it should only be performed by clinical teams with special expertise in interventional cardiology. NICE also encourages further research, through the UK TAVI Trial and the UK Central Cardiac Audit Database, so that more can be learnt about its place in treating patients who would be suitable for surgical aortic valve replacement. Also, we would like to know how well the aortic valves inserted by TAVI work in the long term.” The guidance is available at www.nice.org.uk/IPG421
