Tavi also extended to heart patients at intermediate risk
Discussed, on the occasion of PCR – London Valves 2017, the annual European interventional cardiology conference dedicated to diseases of cardiac valves,
The new Esc/Eacts European guidelines (European Society of Cardiology/European Association for Cardio-Thoracic Surgery) which recommend the extension of the use of the Tavi technique (Transcatheter Aortic Valve Implantation; replacement of the aortic valve for via Transcatetere) in the treatment of patients with intermediate risk aortic stenosis.
“It is an important novelty – explains Giuseppe Tarantini, Director of unit of interventional cardiology, University of Padua and the audience of the ESC/EACTS European guidelines – as to date this intervention technique was reserved for people who are not operable or at high risk for the intervention of cardiac surgery.
Tavi, in fact, is an alternative to the open -hearted surgical operation, dated 2002 and available on a large scale since 2007, to replace the aortic valve in the event of stenosis, that is, the hardening, called calcification, of the valve caused by the process of aging, which leads to the progressive narrowing of its opening,
with limitation of blood flow.
The Tavi intervention, less invasive than the surgical one, is often performed under local anesthesia, through an artery of the groin, using a probe of about 6 mm in diameter.”
On the basis of scientific evidences1 the European Cardiology Society and that of Ccardio-toracic hirurgia They decided to update the guidelines for the treatment of cardiac valve diseases, widening the intervention also to not high risk patients2.
The previous guidelines, issued in 2012, established, however, that the Tavi It was reserved for patients with high surgical symptomatic aortic stenosis.
Over 1 million people are over 65 suffering from cardiac valve diseases in Italy, with aortic stenosis to master: it was estimated, for example,
that the percentage of the population over seventy -five years with aortic stenosis is 3.8% and the one affected by severe and symptomatic aortic stenosis,
That is, the people who according to international guidelines indicate to the valve replacement intervention, both 2%3; in practical terms,
There is talk of about 130 thousand Italians with indication of surgery or to Tavi.
“When the replacement of the aortic valve is indicated, the choice between the two types of intervention, always according to the European guidelines,
It must be taken by a multidisciplinary team called ‘Heart Team’, consisting of interventionist cardiologist, cardiac surgeon, anesthesiologist and other health workers – explains Tarantini. In this way, the best choice for the patient is balanced in the basis of the anatomical and clinical characteristics.
All these recommendations have also been reiterated in a document of the Italian Society of Interventional Cardiology (Gise), which defines the structural and process requirements that the structures in which the Tavi – procedure must have must have; For example, they must be equipped with cardiac surgery –
and indicates a specific training and qualification path of operators.”
“Tavi certainly represents the most appropriate technique in elderly and high surgical risk, should be considered in elderly and intermediate risk patients, but it would be to be assumed even in younger patients, where surgical risk is high. I use the conditional – adds Tarantini – because unfortunately in Italy,
This, like many surgical intervention procedures for via Transcatetere, is penalized: it does not have, in fact, of a code of procedure that identifies it uniquely, nor a specific DRG rate, with adequate remuneration systems, prepared and assigned only in Some regions, with a leopard stain distribution. The result is a big difference in access to Tavi in the country, which involves avoidable migratory flows.”
It will perhaps also be for this reason that Italy is still far away, as regards the offer of this intervention, from countries with whose health systems we are used to dealing, such as Germany, France, but also as Switzerland, Austria or the Nordic countries where The number of valves implanted comes to be double (compared to the million inhabitants) compared to our country.