Wednesday, 16 April 2014

The Unstoppable Risk Creep

  • This registry report, at the recent annual meeting of the American College of Cardiology, on outcomes after TAVI (or TAVR) is a marker for the future.  TAVI (Transcutaneous Aortic valve Implantation) , a percutaneous treatment of aortic stenosis,  is making headway into 'surgical' territory. No-one should be surprised by this. 
    At the moment, within the English NHS, TAVI cannot be offered to a patient with aortic stenosis until that patient is turned down by surgeons - originally 2 and now locally in Yorkshire that seems to have dropped to one. Risk creep i.e. offering TAVI to lower and lower risk patients is real - especially so in the UK, where cardiac surgeons have become risk averse. As lower risk patients are operated on, results invariably get better turning a creep into a canter!
  • What is slowing down the inevitable expansion of TAVI in the National health Service is cost - many institutions are still making a loss with the currently offered tariff.  That will change when the market does open up and unit costs will come down. Edwards, maker of the first TAVI device are clearly trying to delay that time with their silly (IMHO) legal action against Medtronic.
  • As younger and fitter patients undergo TAVI, there will come a point when the patient will start to outlive the prosthesis, which is after all a limited life pericardial prosthesis which has been crushed and deformed!.
  • When that happens will we go back to the extraordinarily safe, effective and long lasting surgical operation or shall we see more TAVI in TAVI procedures? I know what industry would like to see!!
    tags: TAVI aortic stenosis aortic TAVR
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