Transcatheter Aortic Valve Implantation (TAVI)
The Structural Heart Intervention Registries are within the National Cardiac Audit Programme (NCAP). There are four structural heart intervention registeries including Transcatheter Aortic Valve Impantation (TAVI).
The UK TAVI program was established to capture and report outcomes on TAVI procedures performed in the UK. TAVI (transcatheter aortic valve implantation) provides a less invasive alternative to cardiac surgery and avoids the requirement for cardiopulmonary bypass.
The UK TAVI registry was created to define the characteristics and clinical outcomes of the patient population treated with TAVI, regardless of technology or access route, in every centre performing TAVI in the UK.
The project aims to capture detailed information on how TAVI is used to treat patients with severe aortic stenosis and significant comorbidities; improving the care of patients and benchmarking TAVI units to learn best practice.
The practice of collecting comprehensive clinical and outcome data by registry is a significant development in the introduction of new treatment technologies within the NHS. This process may help to shape commissioning by evaluation and encourage the safe introduction of new technologies into the NHS.
The registry is managed by NICOR with clinical direction and strategy provided by the British Cardiovascular Interventional Society (BCIS), the Society for Cardiothoracic Surgeons (SCTS).
The 2024 TAVI report and TAVI Overview of QI metrics covers the 12 months from 01 April 2022 to 31 March 2023.
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Aortic stenosis
The aortic valve opens when blood is pumped from the left ventricle into the aorta, narrowing of this valve (aortic stenosis) affects the efficiency of the heart as a pump.
Aortic valves are normally tricuspid, they have three valve leaflets, but are occasionally bicuspid (two valve leaflets). Aortic stenosis is most commonly caused by the calcification of the aortic valve or following acute rheumatic fever.
Aortic stenosis due to age-related calcification typically occurs in normal tricuspid valves in patients of 70-80 years old. Aortic stenosis in bicuspid valve due to age related calcification typically appears earlier, when the patient is in their 40s or 50s.
Aortic stenosis causes the heart to work harder to counter the decreased volume of blood being pumped. This increase in workload can lead to heart failure.
In patients who are well enough, stenotic valves are replaced surgically. However, there is a population of patients where the risks associated with surgical valve replacement are higher than the potential benefits.
TAVI (transcatheter aortic valve implantation) provides a less invasive alternative to cardiac surgery and avoids the requirement for cardiopulmonary bypass.
TAVI procedures insert the new prosthetic valve inside the existing valve. The new valve is delivered through a catheter inserted transfemorally (via an artery in the groin) or transapically (via an insertion between two ribs). This is possible as the replacement valve is collapsed before being delivered to the correct position in the aortic valve.
The existing stenotic valve is dilated using a balloon catheter, the new valve is positioned and expanded inside the aortic valve ring. The replacement valve is wedged into position against the existing aortic valve ring.
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TAVI 2024 report