Class effect in TAVI: the time has come to know if they are all the same

Abstract

The time has come. Over the past few years, we have been living a constant increase in the number of patients with aortic stenosis who are treated with transcatheter aortic valve implantation (TAVI). Although the latest indications of the clinical practice guidelines from the European Society of Cardiology1 are somehow more restrictive than those of the American College of Cardiology2 regarding age cut-offs and surgical risk we’ve seen a growing demand for TAVI in low-risk patients and, progressively, in younger patients in almost all anatomical settings. Up until now, randomized clinical trials had mostly focused on comparing the TAVI technique to conventional aortic valve replacement surgery.3,4 And although these studies with different models of transcatheter aortic valves laid the foundation for the indications published by the guidelines, very few of them make head-to-head comparisons among the different TAVI models currently available. As a matter of fact, most are observational, non-randomized or non-inferiority clinical trials. On the other hand, the variability of the different models currently available has been growing with technological advances to perform easier, safer, and more durable transcatheter heart valves. However, can we assume that there will be some sort of class effect in all TAVI models currently available? In...