Priority 19 from the Heart Surgery PSP

UNCERTAINTY: How do transcutaneous techniques for heart valve surgery compare to traditional open surgery (TAVI vs AVR)? (JLA PSP Priority 19)
Overall ranking 19
JLA question ID 0088/19
Explanatory note Recommendation on the choice of surgical or transcatheter intervention have been made and updated on current guidelines on the base of 4 major trials and several observational studies. NICE Guidelines on transcatheter aortic valve implantation are available. Despite the abundant amount of evidences, because of the relatively new topic and of the recent advancements in both techniques, further research is mandatory.
~ Compare the outcomes of TAVI valves vs open procedures using either conventional prosthesis or modified TAVI. What are the long-term outcomes from transcatheter valve procedures in the intermediate risk patients?

Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collaboration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. The Annals of thoracic surgery. 2012;93(4):1340-95; Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;63(22):2438-88;
Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-64.

Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples Can catheter based valve insertion be routinely utilized in other positions (i.e mitral or tricuspid) with acceptable long term results? What are the long term outcomes of TAVI vs AVR? ~ Should all patients over 65 be offered TAVI routinely?
Submitted by 19 x healthcare professional, 1 others 
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019