TAVR and SAVR Appropriate Use Criteria Established for Severe Aortic Stenosis

HealthDay News — Appropriate use criteria (AUC) have been developed for the treatment of patients with severe aortic stenosis (AS), according to a report published in the Journal of the American College of Cardiology.

Robert O. Bonow, MD, from the Northwestern University Feinberg School of Medicine in Evanston, Illinois, and colleagues developed AUC for the treatment of patients with severe AS, including use of surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).

The authors developed common patient scenarios experienced in daily practice, along with assumptions and definitions for these scenarios, using guidelines, data from clinical trials, and expert opinion. Ninety-five clinical scenarios were identified, and there were up to 6 potential treatment options for patients. 

An independent rating panel scored each indication according to appropriateness. After considering important confounding factors, the rating panel determined that for most patients with symptomatic AS at intermediate or high surgical risk, SAVR or TAVR is appropriate. Indications for SAVR and TAVR are less clear in certain situations, including when 1 form of valve replacement appears reasonable while the other is less so, and sometimes neither intervention is suitable.

“The purpose of this AUC is to provide guidance to clinicians in the care of patients with severe AS by identifying the reasonable treatment and intervention options available based on the myriad clinical scenarios with which patients present,” the authors write.

Several authors disclosed ties to the pharmaceutical, medical device, and health care industries.

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Aortic Stenosis Writing Group, Bonow RO, Brown AS, et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis [published online October 2017]. J Am Coll Card. doi: 10.1016/j.jacc.2017.09.018.