Interventional cardiology

TAVI funded for intermediate risk patients with severe aortic stenosis

Widening of Medicare-funded access to transcatheter aortic valve implantation (TAVI) is one of several changes to cardiology-related MBS items in March 2022.

For TAVI, reimbursement is being extended to include patients  with symptomatic severe aortic stenosis at intermediate risk for open surgical aortic valve replacement (SAVR).

A new MBS item (38514) will increase the population eligible to receive TAVI from the current criteria of high-risk/inoperable surgical patients with symptomatic severe aortic stenosis (AS).

Until now, patients with symptomatic, severe AS and who were at intermediate risk of surgery either undergo curative surgery with surgical aortic valve implantation (SAVR) or were managed medically with pharmacological treatment, with or without balloon valvuloplasty, to relieve symptoms.

However as previously reported in the limbic, the Medicare Services Advisory Committee (MSAC) approved an application from Edwards Lifesciences for reimbursement of TAVI in intermediate risk patients with its SAPien 3 BEV system.

MSAC’s decision was agnostic of the type of device used, such as self-expandable valves (SEV), similar with the current MBS item for TAVI (and SAVR).

The funding move was welcomed by Dr Yohan Chacko, Interventional Cardiologist, Greenslopes Private Hospital, who said TAVI could offer significant benefits over surgery for those living with severe AS.

“Compared with surgical aortic valve replacement, TAVI offers reduced procedural time, less time in hospital, a shorter recovery period, lower risk of complications, and improved quality of life,” he said.

“In addition, many patients undergoing TAVI are often discharged within 48 hours, offering meaningful patient benefits regarding time in hospital and recovery, compared to surgery.”

Dr Chacko said there were an estimated 97,000 Australians living with severe aortic stenosis, many in the over 65 age group, and the condition was often undiagnosed and untreated.

Another change to MBS items from 1 March 2022, will expand access to Left Atrial Appendage closure procedure for patients with non-valvular atrial fibrillation (NVAF) for stroke prevention.

According to Medicare, MBS item 38276 will be amended to ensure patients with NVAF who have an absolute and permanent contraindication to oral anticoagulation therapy are eligible to access this procedure for stroke prevention. The medical practitioner must not been involved in the decision to provide the surgical procedure.

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