CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 AFRICA 267 2022 SASCI/SCTSSA joint consensus statement and guideline on transcatheter aortic valve implantation (TAVI) in South Africa J Hitzeroth, H Weich, J Scherman Abstract Patients with severe symptomatic aortic stenosis (AS) have traditionally been treated with surgical aortic valve replacement (sAVR). Transcatheter aortic valve implantation is a percutaneous option that has been shown to be at least as effective as sAVR in numerous subgroups of patients with severe AS. This is an update on the previous joint consensus statement and guideline on transcatheter aortic valve implantation (TAVI) in South Africa, published in 2016. It provides guidance on which patients should preferably be offered TAVI over sAVR, with special consideration of the resourceconstrained environment in South Africa. Keywords: TAVI, consensus statement, 2022 Submitted 18/8/22, accepted 2/9/22 Published online 14/10/22 Cardiovasc J Afr 2022; 33: 267–269 www.cvja.co.za DOI: 10.5830/CVJA-2022-049 The South African Society of Cardiovascular Intervention (SASCI) and the Society of Cardiothoracic Surgeons of South Africa (SCTSSA) published the most recent joint consensus statement and guidelines on transcatheter aortic valve implantation (TAVI) in South Africa in 2016.1 Over the last 10 years, TAVI has become an established therapy in South Africa for many patients with aortic stenosis. Based on clinical trial evidence that has become available since then, the TAVI indications have expanded and this treatment modality can now be offered to a broader patient population. In addition to this, the TAVI technology has improved and the implantation technique has been streamlined. This has resulted in excellent procedural outcomes and reduced hospital stays.2 Furthermore, TAVI has been shown to be cost-effective and this is of relevance in the South African resource-constrained environment. The European Society of Cardiology in conjunction with the European Association for Cardio-Thoracic Surgery has recently published the 2021 guidelines for the management of valvular heart disease.3 This consensus statement by SASCI and SCTSSA aims to update the South African guidelines previously published to align them with what is currently considered best clinical practice. This will guide both treating physicians and funders to provide the best therapy for patients. Consensus guidelines on TAVI The decision to proceed to TAVI as opposed to surgical aortic valve replacement (sAVR) must be made in a multidisciplinary heart team (MDT).4 There are numerous factors guiding this decision, which the MDT must weigh up in each individual patient to advise on the optimal intervention. Requirements and structure of the MDT • The performance of TAVI should be restricted to a limited number of high-volume centres, which have both cardiology and cardiac surgery departments on site, with expertise in structural heart disease and high-risk valvular surgery. Additionally, as most complications of TAVI are related to vascular injury, it is important to have clinicians skilled in treating these available on-site. • It is recommended that all TAVI teams aim to perform more than 10 implants per year. • TAVI is reserved for patients who, after evaluation by the MDT, are found to have a risk/benefit analysis favouring TAVI over sAVR. • The MDT should include at least a cardiologist, cardiac surgeon, imaging specialist and, if general anaesthesia is anticipated, a cardiac anaesthetist. Its composition is however dynamic and can also include a geriatrician and neurologist as well as other members as the MDT sees fit. Division of Cardiology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa J Hitzeroth, MB ChB, FCP (SA), Cert Cardiol (SA), jens.hitzeroth@uct.ac.za Division of Cardiology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa H Weich, MBChB, MMed, FCP (SA), Cert Cardiol (SA) Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa J Scherman, MBChB, Dip Occ Med, MMed, FC Cardio (SA) Review Article
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