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Coming to a Consensus on TAVR

Coming to a Consensus on TAVR

In 2011, the FDA approved transcatheter aortic valve replacement (TAVR) for transfemoral use in symptomatic patients with severe aortic stenosis who are not considered candidates for surgery. On behalf of the Society for Cardiovascular Angiography and Interventions, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society of Thoracic Surgeons, my colleagues and I collaborated to develop an expert consensus document on TAVR. The document, published in a 2012 issue of Journal of the American College of Cardiology, is intended to inform physicians on the most appropriate use of TAVR based on available evidence. The consensus document does not recommend universal use of TAVR because the technology is still being investigated. Instead, we recommend that hospitals eligible to perform TAVR should initially be limited to those that are currently performing an average of at least one aortic valve replacement per week. This means that the 400 busiest cardiac surgery programs would be able to access this technology in the first 2 years following FDA approval. After monitoring outcomes, use of TAVR could be expanded or restricted depending on success and failure rates. A Team Approach to TAVR It’s recommended that territorial and specialty-based decisions on treatment with TAVR be avoided by utilizing a heart team approach. This team should include a surgeon, interventional cardiologist, cardiac anesthesiologist, and an imaging specialist. Allied health professionals—including social workers, nutritionists, and physician assistants— should also be involved. Data from the PARTNER trial, which was the initial regulatory trial for TAVR conducted in the United States, indicate that use of heart team approaches may enhance outcomes. “It’s recommended that...
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