NOTICE – Transcatheter aortic valve implantation: Evaluation of the evidence and synthesis of organizational issues

Aortic valvular stenosis, or narrowing of the valve orifice, is a progressive disease that generally affects patients over the age of 65 years in Western countries and is usually caused by degenerative calcification. Aortic stenosis causes increasing resistance against the ejection of blood from the left ventricle towards the aorta. Aortic stenosis represents the third most common cardiovascular disease among adults and the most frequent cardiac valve illness among elderly persons in the industrialized world.

Until recently, the only effective therapy for severe or symptomatic aortic stenosis was surgical valve replacement, but about a third of elderly patients can be refused this procedure due to their health status or aortic anatomy, which renders surgery too risky. In 2002, a percutaneous technique for implanting an aortic valve was developed, allowing the delivery by catheter and deployment of an aortic valve bioprosthesis, without recourse to open-heart surgery. However, there are no canadian clinical practice guidelines specific to TAVI, and the criteria for selection of patients raise important questions.

A narrative review of the literature and an analysis of the Quebec experience was published in 2010 by a working group of the Réseau québécois de cardiologie tertiaire (RQCT). Following the release of this document, the ministère de la Santé et des Services sociaux (MSSS) recommended that this procedure be used only for patients who cannot be treated by traditional surgical methods due to an excessive risk of complications. Also, the MSSS gave the INESSS the mandate to perform an evaluation of TAVI.

Considering the results of our evaluation and discussion of these with a scientific committee of Quebec clinical experts, INESSS made recommendations particularly concerning patient selection criteria and process, organizational issues related to the practice of TAVI, requirements for performing centres and provincial registry.