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NHS England's new commissioning criteria for TAVI in intermediate and low-surgical risk patients
In February 2023, NHS England released the position statement on Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) for symptomatic, severe aortic stenosis in adults.
NHS England has a published policy for TAVI of 2013, in which eligible patients are defined as at high surgical risk. This new position statement sets criteria for intermediate and low-surgical risk patients who are eligible for TAVI. NHS England concluded that in the context of elective performance, TAVI might offer an appropriate alternative to cardiac surgery (SAVR) in selected patients. Decision-making by the aortic valve multidisciplinary meeting (MDM) should govern the patient selection, valve and device type, and associated complication profiles.
Patients must meet all the inclusion criteria and do not have exclusion criteria to be eligible for TAVI.
Risk scores such as the Society of Thoracic Surgery Predictor of Mortality (STS-PROM) or European System for Cardiac Operative Risk Evaluation (EuroSCORE II) should be used, but account also needs to be taken of factors that may not be captured in the risk scores:
- Extreme or high risk for SAVR is defined as an estimated surgical risk of in-hospital mortality ≥8%; this includes patients considered inoperable;
- Intermediate risk for SAVR is defined as an estimated surgical risk of in-hospital mortality of 4-8%;
- Low risk for SAVR is defined as an estimated surgical risk of in-hospital mortality of ≤4%. Patients in this group could be considered for TAVI where patient anatomy is favorable, and the patient is either aged ≥ 80 years or aged ≥ 70 years with comorbidities that could influence recovery.
See more information here.
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