Evolving paradigms in valvular heart disease: where should guidelines move?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Heart Valve Disease

Background:

• The field of valve intervention is evolving rapidly, with clinical practice guidelines informed by evidence and experience.
• Current guidelines for transcatheter aortic valve implantation (TAVI) indications primarily focus on high- and intermediate-risk patient subgroups.

Purpose of the Study:

• To discuss the paradigm shift towards considering TAVI as a default strategy for the majority of patients, including low-risk individuals, based on new evidence.
• To emphasize the importance of patient-centered decision-making and the role of the Heart Team in optimizing patient pathways.
• To review emerging evidence regarding secondary mitral regurgitation and mitral edge-to-edge repair.

Main Methods:

• Review of randomized trials concerning TAVI indications in high- and intermediate-risk patients.
• Analysis of new evidence supporting TAVI in low-risk patient populations.
• Discussion of factors influencing treatment decisions, including patient characteristics, longevity, and device durability.

Main Results:

• Emerging evidence suggests TAVI may be the default strategy for most patients, representing a significant shift from established practices.
• Patient factors, longevity, and durability are critical considerations for Heart Team discussions and decision-making.
• Further developments in managing secondary mitral regurgitation with mitral edge-to-edge repair are also highlighted.

Conclusions:

• The optimal management of aortic valve disease is shifting towards a patient-centered approach with TAVI as a potential default strategy.
• The Heart Team plays a vital role in integrating patient-specific factors into treatment decisions.
• Ongoing research into mitral valve interventions continues to expand therapeutic options.