Transcatheter aortic valve implantation for patients with symptomatic severe native aortic stenosis

Published on 29 Sep 2021
Last Updated on 28 Mar 2025

Guidance Recommendation

The Ministry of Health’s Medical Technology Advisory Committee has recommended transcatheter aortic valve implantation (TAVI) for symptomatic severe native aortic stenosis (AS) in line with the following criteria:

✓ TAVI may be considered for patients with symptomatic severe native AS who are inoperable or have an unacceptably high risk of mortality from surgical aortic valve replacement (SAVR) surgery and significant comorbidities.

✓ Patient selection should be carried out by a multidisciplinary heart team, which must at minimum include an interventional cardiologist and a cardiac surgeon. The team should determine the surgical mortality risk for each patient based on:

• An estimated mortality risk of 11% or greater within 30 days of surgery, according to the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) risk assessment; OR

• Other patient characteristics where these conditions are clinically equivalent to inoperable risk (STS-PROM score ≥11%). These examples could include but are not limited to those listed in the Annex. Where appropriate, objective tools should be used to assess these characteristics.

✓ TAVI should be conducted by a multidisciplinary heart team that has met the applicable TAVI training and accreditation standards set by the institution.

✓ The TAVI procedure should be performed via transfemoral delivery, unless it is contraindicated or not feasible, in catheterisation labs or hybrid operating theatres equipped with early in-hospital access to cardiac and vascular surgical support for the emergency treatment of complications and subsequent patient care.

✓ Properly record details of final surgical risk assessments of all patients who receive TAVI including STS-PROM score, type of TAVI device and clinical outcomes. This is consistent with the standard arrangements in place for clinical governance and audit.

Funding status

TAVI is recommended for inclusion on the MOH Implant Subsidy List (ISL). Listed models are recommended for subsidy when used in line with the abovementioned recommendations.

TAVI should not be subsidised if the patient has received a prior SAVR or TAVI implant.

Transcatheter aortic valve implantation for patients with symptomatic severe native aortic stenosis (Published 28 Mar 2025)

Transcatheter aortic valve implantation for patients with symptomatic severe native aortic stenosis Annex (Published 28 Mar 2025)