[Aortic stenosis in the elderly: The TAVI revolution]

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe symptomatic aortic stenosis necessitates intervention, with Transcatheter Aortic Valve Implantation (TAVI) an option for patients at prohibitive, high, or intermediate surgical risk.
• Surgical risk is estimated using scores like STS score and EuroSCORE II.
• Clinical decisions involve evaluating comorbidities, TAVI feasibility, and concurrent pathologies requiring surgical correction.

Purpose of the Study:

• To outline current recommendations and considerations for choosing between Transcatheter Aortic Valve Implantation (TAVI) and traditional open-heart surgery for severe aortic stenosis.
• To highlight the role of the Heart Team in decision-making.
• To discuss favored access routes and potential complications associated with TAVI.

Main Methods:

• Review of current clinical guidelines and expert consensus regarding Transcatheter Aortic Valve Implantation (TAVI) for severe symptomatic aortic stenosis.
• Emphasis on the multidisciplinary Heart Team approach for patient selection.
• Consideration of transfemoral access as the preferred route.

Main Results:

• Transcatheter Aortic Valve Implantation (TAVI) is a viable alternative to surgery for specific patient groups.
• Key factors influencing the choice include patient comorbidities, surgical risk scores, and technical aspects of TAVI.
• Common TAVI complications include conduction disturbances, stroke, bioprosthesis thrombosis, and concerns about durability.

Conclusions:

• The decision between TAVI and surgical aortic valve replacement requires careful, individualized assessment by a Heart Team.
• Transfemoral access is generally preferred for TAVI.
• Post-TAVI management includes a 3-6 month course of dual antiplatelet therapy (aspirin and clopidogrel), followed by long-term single antiplatelet therapy with aspirin.