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Can J Cardiol. 2019 Nov;35(11):1437-1448. doi: 10.1016/j.cjca.2019.08.011.

2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation.

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Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada. Electronic address:
Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Health Sciences Centre, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
McGill University, Montreal, Quebec, Canada.
Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Universite de Laval, Quebec, Quebec, Canada.
Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada.


Transcatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at intermediate surgical risk. Recent clinical trial data have shown the benefits of this technology in patients at low surgical risk as well. This update of the 2012 Canadian Cardiovascular Society TAVI position statement incorporates clinical evidence to provide a practical framework for patient selection that does not rely on surgical risk scores but rather on individual patient evaluation of risk and benefit from either TAVI or surgical aortic valve replacement. In addition, this statement features new wait time categories and treatment time goals for patients accepted for TAVI. Institutional requirements and recommendations for operator training and maintenance of competency have also been revised to reflect current standards. Procedural considerations such as decision-making for concomitant coronary intervention, antiplatelet therapy after intervention, and follow-up guidelines are also discussed. Finally, we suggest that all patients with aortic stenosis might benefit from evaluation by the heart team to determine the optimal individualized treatment decision.


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