Sunday, 20 November 2011

Technology Dispersal and which Patients should receive treatment.

The traditional way of replacing a diseased aortic valve is through a stenotomy incision and open heart surgery. When patients are turned down for surgery, they have, until recently, been treated conservatively. Prognosis for this group of patients is very poor with most of them dying within 2 years of presenting. Over the past 2 years, a new therapeutic option has become avaialble  - TAVI or transcutaneous aortic valve implantation. A randomised controlled study (the Partner study) has confirmed survival advantage of this device when implanted into patients with aortic valve stenosis who have been turned down for surgery when compared to those treated conservatively. Both NICE and the FDA have approved the use of this device for patients turned for surgery. This article published recently in JAMA outlines how dispersal of the technology is being achieved in North America - with the cooperation of regulatory authorities and cardiology and cardiothoracic professional bodies. NICE consults professional bodies but its provisional guidance regarding suitability of use in patients who have been turned for surgery does not translate into actual dispersal of the technology. Decisions as to who receives the treatment are left to unaccountable commissioners. Patients in many areas of England and in the whole of Scotland do not have access to this form of treatment and are dying prematurely. Although FDA approval in the USA came late, it is likely now that the technology will be disseminated in an orderly logical fashion.  Not sure of when TAVI became TAVR - as the native valve is left insitu, it's not quite a replacement.