Transcatheter Aortic Valve Implantation (TAVI) in Singapore: Cost Effective After a Decade of Evolution?

Chiam PT, Ho KW, Keng FY. Transcatheter aortic valve implantation in Singapore: Cost effective after a decade of evolution? Annals, Academy of Medicine, Singapore 2020; 49: 420-422.

Aortic stenosis (AS) is a common valvular disease in developed countries and when untreated, symptomatic severe AS can result in a 50% mortality at 1–2 years.
Transcatheter aortic valve implantation or replacement (TAVI or TAVR) was first performed as an alternative to surgical aortic valve replacement (SAVR) in a no-option
patient.Clinical trials, starting with inoperable severe AS patients, showed that TAVI reduced mortality when compared to medical therapy, and was non-inferior
or even superior to SAVR in high or intermediate risk patients. More recently, TAVI has also been shown to be superior—with a lower major stroke or death and rehospitalisation rate—to SAVR in low risk patients. Since TAVI was first performed in Singapore (and Asia) in 2009, the technology has evolved, and third generation devices are currently in use with improved clinical outcomes.


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