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A Journal on Internal Medicine

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Minerva Medica 2014 December;105(6):487-95

language: English

Is TAVI superior to surgery in high-risk patients? Insight into the concept of individual risk assessment

Benfari G. 1, Onorati F. 2, Rossi A. 1, Abbasciano R. 2, Zivelonghi C. 1, Salsano A. 3, Ribichini F. 1, Santini F. 3, Vassanelli F. 1, Mazzucco A. 2, Faggian G. 2

1 Division of Cardiology, University of Verona Medical School, Verona, Italy;
2 Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy;
3 Division of Cardiac Surgery, San Martino Hospital University of Genoa, Medical School, Genoa, Italy


The prevalence of aortic valve stenosis (AS) is growing in developed countries because its prevalence increases with age. A growing number of elderly patients are currently referred to specialized centres to be evaluated for potential therapeutic strategies. Indeed, two techniques are nowadays able to treat high-risk AS patients: TAVI and surgical replacement (AVR). It is the purpose of the present review to summarize current knowledge on safety and efficacy of AVR and TAVI in high-risk patients; to focus on some aspects of recently published guidelines; to emphasize the growing importance of pre-operative individual risk assessment, which is considered the real crucial point for patient selection and trial’s comparisons. Indeed, it is worth of noting that currently adopted risk-scores do not show satisfactory performances. Accordingly, it becomes of utmost importance to investigate several baseline but still neglected patients’ characteristics (e.g. frailty, functional status, co-morbid conditions, etc.), as well as their pathogenetic relationships with interventional results and follow-up prognosis. All these items are emphasized in the present review. Finally, we have tried to anticipate future scenarios in terms of both ongoing clinical trials and improvements of risk-scores.

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