From the Desk of the President Elect
Two Months In: TAVI, Trials, and a Team That’s Just Getting Started
23 May 2025
Two Months In: TAVI, Trials, and a Team That’s Just Getting Started
From the (very full) desk of the President-Elect, SCTS
It’s been a whirlwind couple of months since stepping into the leadership roles at the Society for Cardiothoracic Surgery (SCTS), and this week marked our official two-month anniversary. With most of the senior team away in Blackpool examining (presumably between ice creams and viva questions), the President and I took a moment to reflect.
The consensus? It’s been a steep learning curve, but an incredible honour. Being elected by our peers to help steer the specialty forward is no small thing — and we’re rolling up our sleeves.
The TAVI Tipping Point
This week, attention turned sharply to a major issue in adult cardiac surgery: transcatheter aortic valve implantation, or TAVI.
It kicked off with a powerful piece in The Guardian (May 19), highlighting the growing crisis of long waiting lists for TAVI procedures. One heartbreaking case — a 68-year-old woman, reportedly fit and healthy — died while waiting for the intervention. The piece struck a chord with both the public and the profession.
Read the article
SCTS members would likely agree with the article’s main message: severe aortic stenosis is deadly. Quick diagnosis followed by prompt treatment is non-negotiable. But it also raised serious questions — especially about patients like the one featured. If she was truly otherwise healthy, current guidelines suggest that surgical aortic valve replacement (SAVR) would have been more appropriate than TAVI.
That led us to a broader concern: Are patients being routed to TAVI without proper multidisciplinary (MDT) discussion? Are potentially surgical candidates languishing on ever-growing TAVI lists?
In response, we wrote to The Guardian's editor, expressing strong support for quicker access to treatment and for patients being fully informed of their options — including the excellent results from surgical AVR. Especially for younger, fitter patients, surgery shouldn’t be overlooked.
Read the letter
Engaging the NHS: A Step Forward
Later in the week, we met with NHS England — including Lydia Ball, the lead commissioner for cardiac services. TAVI capacity and waiting times are now clearly on the NHS radar too, as are rising concerns about high volumes of urgent, in-house TAVIs that consume significant resources.
The outcome? A new collaborative project to assess the true national picture. If evidence supports the concerns raised, we’ll work with NHS England to revise commissioning guidelines.
A small victory, perhaps — but proof that when we engage at the centre, real change is possible.
Surgery Still Faces Its Own Challenges
Of course, we can’t ignore that access to surgical AVR is far from perfect. Some centres continue to struggle with ICU and ward bed availability, putting the brakes on throughput.
That’s why our top priority remains clear: promote minimally invasive surgery (MIS) and enhanced recovery after surgery (ERAS). Following our recent visit to Ancona, we’ve been deep in discussions with both the Association for Cardiothoracic Anaesthesia and Critical Care and NHS specialist commissioners to finalise a UK-wide dissemination strategy.
The goal? Make MIS and ERAS standard practice across the country — improving recovery, cutting wait times, and offering patients a better experience, which they tell us is important when choosing between surgery and TAVI.
Backed by Evidence (Not Just Industry)
Another major frustration in recent years has been the influence of industry-funded trials on international practice guidelines — often using narrowly selected patients and short-term outcomes that don’t do surgery justice.
That’s why I’m thrilled to announce that, alongside Dan Blackman (interventional cardiologist, Leeds), we’ve secured nearly £800,000 for the NAVIGATE BICUSPID trial — an ambitious, 10-year international study comparing TAVI and SAVR in patients with bicuspid valves.
These patients were excluded from the trials underpinning current guidelines, even though the use of TAVI in this group is rising. Early results from NOTION 2 show worrying outcomes, but that study was small. NAVIGATE will involve 1,500 patients, with meaningful long-term results.
Importantly, both surgeons and cardiologists will collaborate to select patients, and surgical voices will help oversee the trial — a rare but crucial development. This is real, independent science in action, and a big win for evidence-based surgery.
And Finally… A Huge High-Five to Team Thoracics
To end on a high: massive congratulations to our thoracic colleagues leading the RESTORE trial for pectus excavatum.
When I was awarded the £2.2 million NIHR grant as Chief Investigator, I thought this might be the toughest RCT I’d ever run. We had to reboot clinical services for pectus surgery in 10 UK centres — most hadn’t done the procedure since it was decommissioned in 2019.
But against the odds, it’s working. The trial is not only on track — it’s ahead of schedule. All participants have been consented, and nearly 80% are already randomised. We’re now expecting to finish a full year early. That’s almost unheard of in surgical trials.
It’s a brilliant result for the team — and even better news for patients.
So here’s to progress, partnerships, and pushing the specialty forward — two months down, and a lot more to come.
Enoch Akowuah
SCTS President-Elect
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