Severe aortic stenosis and the need for the right treatment, in the right place, at the right time

Correspondence to Dr Aidan W Flynn, Cardiology, Health Service Executive Saolta University Hospital Group, Ballinasloe 98195, Ireland; aidan.flynn@hse.ie Severe symptomatic aortic stenosis (AS) is a class I indication for aortic valve replacement (AVR), and AVR should be performed in a timely manner,1 acknowledging such caveats as other life-limiting conditions and patient preference/consent. [...]ST segment elevation myocardial infarction (STEMI) is a class I indication for primary percutaneous coronary intervention (PCI) and should be performed in a time-sensitive manner,2 again acknowledging the aforementioned caveats. The obvious answers include a combination of the following: having a suitably resourced heart valve team; contributions from all referring cardiologists who have overseen the diagnostic tests are essential, therefore removing the need for repeat imaging; having a uniform referral pathway/checklist will avoid delays caused by incomplete diagnostic testing; generating an ‘active list’ so that patients are on a single list (avoiding an ‘out-of-sight, out-of-mind’ mentality); regular updating of the list, with further discussion of patients after a period of time (2 months) on the list; and greater resourcing of the TAVI-operators, in terms of procedural space and dedicated time.