The Ministry of Health’s MTAC has recommended subsidy for:
- Transcatheter aortic valve implantation (TAVI) may be considered in patients with symptomatic severe aortic stenosis (AS) who are inoperable or have an unacceptably high risk for SAVR with 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 risk level of each patient based on:
- The estimated risk of mortality 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 that preclude surgery such as frailty and cognitive function. 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 prescribed 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.
- Consistent with the standard arrangements in place for clinical governance and audit, details of final surgical risk assessments of all patients who receive TAVI including STS-PROM score, type of TAVI device and clinical outcomes, should be properly recorded.