What Are SAVR Indications in the TAVI Era?

While surgical aortic valve replacement (SAVR) has traditionally been regarded as the gold standard for severe symptomatic aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) has emerged as a compelling less invasive alternative for patients with severe AS across the entire surgical risk spectrum. Despite TAVI's increasing utilization and promising outcomes, SAVR continues to be an essential treatment modality for certain patient populations, including individuals with complex aortic anatomies unsuitable for TAVI, patients presenting with significant aortic regurgitation, individuals requiring concomitant surgical procedures, and cases involving infective endocarditis. Furthermore, concerns regarding the long-term durability and complication profile of transcatheter valves underscore the importance of individualized patient assessment, especially for younger patients requiring optimal lifetime management strategies. This review examines the evolving role of SAVR amidst the growing adoption of TAVI and highlights key considerations for selecting the most appropriate treatment strategy for patients with aortic valve disease, incorporating insights from recent advancements in transcatheter technologies and the latest clinical trial evidence.