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Published on 29 Sep 2021
Last Updated on 29 Sep 2021
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Guidance Recommendation

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.

Subsidy status

Subsidies for the abovementioned indications apply only to the devices listed in the Annex. TAVI should not be subsidised if the patient has received the TAVI implant subsidy within the preceding five-year period.

Transcatheter aortic valve implantation (TAVI) for patients with symptomatic severe aortic stenosis Transcatheter aortic valve implantation (TAVI) for patients with symptomatic severe aortic stenosis (Annex)