What we looked at and why

SHTG recommendation

In response to enquiry from the NHS Scotland Strategic Planning Board

What were we asked to look at?

We were asked to review the evidence comparing TAVI with SAVR for the treatment of people with symptomatic severe aortic stenosis who are at low surgical risk

Why is this important?

Aortic stenosis is the most common heart valve disease in adults in Europe.^{1, 2} The prevalence of aortic stenosis increases steeply with age and is expected to become more prevalent as the Scottish population gets older.¹ Without intervention, people with symptomatic severe aortic stenosis have a poor prognosis, with an average life expectancy of 2–3 years and survival rates of 15–50% at 5 years after diagnosis.¹

For people with symptomatic severe aortic stenosis the two main treatment options are SAVR and TAVI. Data from randomised controlled trials (RCTs) in people with symptomatic severe aortic stenosis who are at high or intermediate surgical risk show that TAVI is either as good as or better than SAVR.¹ Approximately 80% of people with symptomatic severe aortic stenosis who are suitable for SAVR are defined as low surgical risk.³ This review examines the evidence for TAVI compared with SAVR in the low surgical risk population.

What was our approach?

We reviewed the published literature on the clinical effectiveness, cost effectiveness, safety and
patient experience of TAVI for the treatment of symptomatic severe aortic stenosis in people at low surgical risk. More information about SHTG Recommendations is available on our website.

What next?

Our recommendations will be used by the NHSScotland Strategic Planning Board to inform decisions on the provision of TAVI across Scotland, including whether TAVI should be offered to people with symptomatic severe aortic stenosis who are at low surgical risk.