1640 – Transcatheter Aortic Valve Implantation (TAVI) via transfemoral delivery for patients at low risk for surgery

Amendment to an existing MBS item.

The TAVI procedure relevant to this application consists of the transfemoral insertion of a minimally invasive prosthetic heart valve that is positioned within the native aortic annulus. Once in situ, the valve is expanded while the heart is rapidly paced. The procedure is performed under fluoroscopic and transosophageal guidance and under general anaesthesia or sedation and local anaesthetic.

The TAVI procedure can be performed using either a self-expandable, mechanically expandable or balloon-expandable device. Once the correct position is confirmed, the heart is again rapidly paced, the balloon or valve is expanded until the device meets native annular walls, and the guide wire, catheter and balloon (if present) are removed.

Type: Therapeutic

Severe Aortic Stenosis (AS) is the abnormal narrowing of the aortic valve, which restricts the flow of blood from the left ventricle of the heart into the aorta. When the heart contracts to pump oxygenated blood from the left ventricle into the aorta, the aortic valve opens. If the aortic valve is narrowed, the heart no longer pumps blood efficiently and therefore, increases the blood pressure inside the left ventricle. In response to the extra workload, the muscle of the left ventricle thickens (concentric hypertrophy) and the chamber itself may eventually balloon out. Left untreated, congestive heart failure develops and death is likely.

This application is relevant to patients with severe, symptomatic AS classified as being at low risk for surgery. ‘Low risk’ is historically defined by a predicted 30-day risk of surgical mortality of <4%, based on the Society of Thoracic Surgeons Predicted Risk of Mortality score.

• PASC meeting: Expedited – bypassing PASC
• ESC meeting: 10 to 11 June 2021
• MSAC meeting: 29 to 30 July 2021