4 | HOSPITAL HEALTHCARE EUROPE | 2022

Advancing age brings with it a range of health problems , one of which can be a stiffening of the aortic valve , leading to mechanical obstruction of blood flow across the valve and termed aortic stenosis ( AS ). It is the most common primary valve lesion requiring surgery or transcatheter intervention in Europe and North America . ¹ Aortic stenosis affects about 5 % of the population at age 65 and it becomes more common with increasing age , ² affecting an estimated 12.4 % of those aged 75 years and older . ³ Clinically , patients with AS experience breathlessness , dizziness , syncope and angina and while surgical aortic valve replacement is the optimum treatment , this option is inappropriate for older , frail patients , especially those with co-morbidities that place them at an unacceptably high surgical risk .

With many older AS patients unsuitable for surgery , there was an urgent need to find a suitable and effective alternative intervention . On 16 April 2002 , Professor Alain Cribier performed the very first transcatheter aortic valve replacement procedure at the Charles Nicolle University Hospital in Rouen , France . ⁴ Over time , the procedure was refined , and in 2007 , Walther et al ⁵ described the successful use of a minimally invasive transapical beating heart aortic valve implantation for high-risk surgical patients with AS . By 2011 , Webb and Cribier ⁶ described how TAVI was assuming a major role in the routine management of patients with AS and that after 10 years of experience , TAVI appeared to be a reasonable option for some operable but high-risk patients . Over time , TAVI has had a significant uptake , with more than 500,000 procedures performed worldwide in more than 70 countries . ⁷

The purpose of this educational resource is to offer readers a greater insight into the current use of TAVI from the perspective of interventional cardiologists in the UK and across Europe . Hospital Healthcare Europe had the pleasure of speaking with key opinion leaders to gain a better understanding of their perceptions of TAVI on aspects such as patient outcomes and hospital budgetary efficiencies .

One overarching and recurring theme throughout the interviews is that with an increasingly ageing population , the introduction of TAVI has enabled cardiologists to increase patient throughput , and , with a considerably shorter recovery time compared with surgery , there are clear benefits to hospital efficiencies .

In addition , Hospital Healthcare Europe wanted to explore their views on the evolution of the procedure and the future technological advancements that they felt necessary to improve the procedure further . Finally , as virtually all areas of healthcare have been negatively affected by the COVID-19 pandemic , we wanted to know how this had impacted each of the centres ’ ability to deliver TAVI .

We hope you enjoy reading this educational resource and that it provides you with valuable insight into TAVI from the viewpoint of the experts at the very forefront of this technique .