the use of TAVR. The introduction of TAVR and
other new catheter-based therapies have made
VHD management increasingly complex, as they
have expanded patient options but increased the
difficulty of discerning the risk-benefit ratio. The
guidelines thus provide separate recommendations on both the timing and choice of these new
interventions.
Using TAVR as an example, outcomes have
significantly improved from the initial randomized
trials of 2006 and the paradigm and question has
changed from whether TAVR is appropriate for the
sicker patients to whether TAVR will be the first
choice for AS therapy in most patients. Granted, aspects of frailty and futility are yet to be determined,
plus there remains a need for improvements relat-
ing to prevention of stroke, need for pacemaker, and
paravalvular leak that must continue to develop.
As Dr. Nishimura put it at ACC.15, these really
are guidelines for the 21st Century.
THERE IS AN ‘I’ IN THIS TEAM
The guidelines support the application of a heart
team approach, which is now a central concept in
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