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.