Call for hospitals to offer suitable patients a 'minimally invasive' alternative to open heart surgery

Public patients who are not able for open heart surgery should be offered an alternative landmark operation which could transform their care, a new report by the country’s health watchdog said today.

The procedure known as transcatheter aortic valve implantation (TAVI) is a minimally-invasive alternative to open heart surgery.

It should be offered to suitable patients who have a stiff or narrowed aortic valve that doesn’t let blood pass as it should, the report from health watchdog Hiqa to the Minister for Health Simon Harris and the HSE said.

Hiqa was asked to do an assessment of the procedure to determine if it should be made available to more public patients.

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Aortic stenosis arises when one of the four valves of the heart becomes narrowed, making it difficult for the heart to function properly.

The condition typically affects older people, those aged 70 years or older, but it can also occur in younger patients.

The standard treatment in patients that are otherwise inoperable or at high risk of surgical complications is open heart surgical aortic valve replacement (SAVR) .

However, Hiqa Chief Scientist Dr Conor Teljeur said: “Clinical trials have demonstrated that TAVI is just as safe as SAVR in terms of cardiac and all-cause mortality.

“Although some other complications differ between TAVI and SAVR, the minimally invasive procedure is associated with a shorter length of stay in hospital and improved health-related quality of life gains in the short term (up to three months) compared with open heart surgery.”

Between 3pc and 4pc of adults aged 75 years and older have severe aortic stenosis, of which three-quarters are symptomatic.

“If left untreated, 40pc of patients with the condition will die within five years – which is about double the mortality rate of their peers.

“Replacing or repairing the damaged valve is the only known cure. Standard care, or so-called surgical aortic valve replacement (SAVR), involves open heart surgery to replace the damaged valve. As TAVI does not involve open surgery it may offer health benefits to patients, such as faster recovery from the procedure.“

With fewer costs arising from a shorter hospital stay, and improved quality of life gains arising from a faster recovery time, TAVI is considered more cost-effective than SAVR in patients at intermediate and low surgical risk in Ireland.

There would also be no additional cost to the HSE over the next five years if TAVI was provided to these patients instead of SAVR. However, the long-term durability of TAVI valves is uncertain, and there is limited evidence to support the use of TAVI in patients under 70 years of age.

Dr Teljeur added: “Extending TAVI to patients at lower levels of surgical risk is likely to be no more expensive to the HSE over the next five years than if patients were to continue to be treated using SAVR.

“The economic advantage of TAVI is in the reduced length of stay in hospital. By switching patients from SAVR to TAVI, there will be an opportunity to release hospital beds, surgical staff, and theatre time to address other demands in the healthcare system.”

The HTA of TAVI in patients with severe symptomatic aortic stenosis at low and intermediate-risk of surgical complications was approved by the Board of HIQA last week and has been submitted to the Minister for Health, Department of Health, and the HSE for consideration.

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