TAVR in LATAM: Hope vs. Reality
Latin American interventional cardiologists have been involved in structural heart disease programs since the very beginning. Although rheumatic valve diseases have significantly decreased, ageing population is steadily increasing its degenerative heart valve disease.
After the early stages of balloon valvuloplasty procedures – mainly for mitral valve in the adult population, but also other procedures for children and young patients – and following the pioneer cases of TAVR, the first self-expandable valve aortic valve was implanted in Latin America.
Beyond that, other first-in-human experiences with other devices were also done in the region. Nevertheless, the transition from research to clinical practice has suffered significant challenges.
Although the technique was early embraced by interventionists and accepted by clinicians, the implementation in the daily practice is still beyond the evidence and the expectancy, mainly because of several restrictions in reimbursements.
In most of the countries, TAVR is only accepted for nonsurgical candidates, and heart team decision in many cases is changed if a surgeon accepts to perform surgery on the patient.
Key Opinion Leaders (KOL) and local medical societies have played a significant role in supporting the use of this life-saving technique and their major role is still mandatory.
Regarding other new techniques, I should mention that there are several programs of pulmonic valve replacement, not only with traditional THV but also with new devices in the early clinical experience.
Mitral valve repair is also performed, but its penetration in the daily practice is even much more limited than TAVR. There is very small experience about tricuspid and we still have a long way ahead for all these programs.
Any collaborative initiative – like National Heart Valve Awareness Day – promoted by international societies and supported by KOL from around the world are extremely useful for Latin America, where we still have to work hard to increase and improve diagnosis and different therapeutic options for our patients, including all these new minimally invasive and surgical techniques.
This article was authored by Oscar A. Mendiz, MD, FACC, director of the Cardiology and Cardiovascular Surgery Institute at the Hospital and Favaloro University in Argentina. Follow Dr. Mendiz on Twitter: @omendiz