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TAVI is one of the biggest revolutions in cardiovascular medicine over the last decades and one that has had a significant impact on the lives and outcomes of patients already hospitalised . Nevertheless , the restrictions imposed by the pandemic did lead to a reduction in the overall number of procedures performed adding that , sadly , “ some patients died during the pandemic just waiting for the elective intervention .” On the positive side , however , some intermediate- or low-risk patients destined for elective surgery were treated with TAVI instead , simply because of a lack of intensive care beds .
Looking to the future , what innovations would you like to see ? Dr Taramasso feels that an important innovation would be a valve that is easy to orientate in each patient . He added that currently sealing the valve is not a problem , with few cases of paravalvular leakage occurring but mentioned valve durability . Ideally , he added “ a valve with good durability , a low gradient , even in small anatomy and good haemodynamics , would be a further improvement .” He also felt that physicians should be able to improve on the insertion of the valve to reduce the pacemaker rate , which can be lowered by inserting the valve higher , although the pacemaker rate did vary with the brand of valve used . Although mortality is a potential problem , Dr Taramasso stated that this was dependent upon the patient ’ s risk category . “ If you treat a low-risk patient , then the risk of death should be , and usually is , less than 1 %, but for a high-risk patient or a complicated case , the risk is between 1 % and 3 %.”
Final words As a firm believer in TAVI , Dr Taramasso is keen to move towards treating low-risk , younger patients once there is clear and convincing evidence for the longer term durability of the currently available TAVI valves . >