Dr OP Yadava, New Delhi    01 December 2017

TAVR is a welcome development and is a big boon for a large number of patients with clinically significant aortic valve pathologies which are deemed prohibitive risk for SAVR. However it is a technology in continuous evolution and has not yet matured enough to be applied to low surgical risk cases. Issues concerning paravalvular leak conduction abnormalities need for permanent pacemaker and stroke cognitive dysfunction continue to be its bug bear. Experience of surgical bioprosthesis show that inflection point for degeneration with second and third generation valves is around 10 12 years and 12 15 years respectively. Till TAVR reaches this point one must reserve the jury in matters of durability. New issues like HALT and HAM need further enquiries including the role of anticoagulant therapy and their duration of use. Universal applicability due to costs and in pathologies like AR bicuspid aortic valve is sub judice. Further advances in SAVR like sutureless valves and minimally invasive techniques have reduced the level of invasiveness to seriously challenge TAVR.

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