Transcatheter aortic valve implantation: Coming of age

Abstract

Transcatheter aortic valve implantation (TAVI) has achieved ide spread adoption in many centres worldwide for the treatment f non-operable and high-risk patients with severe aortic stenosis. abate et al. present results from a national registry database repesenting 80% of all TAVI cases performed in Spain since January 010, including both available prostheses (Medtronic CoreValve nd Edwards SAPIEN) and all vascular access routes utilized.1 This eport provides valuable insight into the overall profile of TAVI nd treatment of high-risk aortic stenosis patients within a speific country. Many other published registries provide fragmented ata with outcomes based upon a specific device, access route or elected centres, introducing biases and limiting generalizability of he data. These results confirm that technical proficiency has been roadly achieved in Spanish TAVI centres with good procedural sucess rates and excellent perioperative outcomes. Their early and -year results are similar to other published registry data from anada, United Kingdom, France, Germany, Italy, Belgium and Ausralia/New Zealand,2 which is reassuring for the implanting TAVI eams as well as their patients. The authors and all participating TAVI teams in Spain should be ongratulated on a number of different levels. This report repreents the successful creation of a central National TAVI Committee o prospectively collect high-quality patient data on TAVI proceures from most of the implanting centres in Spain. This is an mpressive feat, particularly in the highly politicized climate of AVI, that demonstrates great collaboration between cardiovasular centres and amongst cardiology and cardiac surgery teams. hese partnerships are critical for achieving optimal patient outomes and for the future of transcatheter valve therapies. This panish central data repository will serve as an invaluable resource ot only to monitor trends in TAVI procedures and patient outomes but will become a powerful vehicle to develop new science nd perform multicenter, randomized trials necessary to advance he field of TAVI. Reporting TAVI patient outcomes from a central, ational registry helps to reduce the impact of the usual biases nherent to observational case studies, so commonly present within he TAVI literature. Consideration could be made to expand the atabase to include all patients with severe aortic stenosis, in paricular, medical therapy alone and conventional surgical aortic alve replacement outcomes, so to provide more comprehensive ata on the outcomes of the entire disease process itself. If the emaining Spanish TAVI centres could be convinced to participate n this initiative as well, it could become a very powerful resource orldwide for TAVI research.