Transcatheter Aortic Valve Implantation Indications and Patient Selection

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe aortic stenosis (AS) management has shifted significantly.
• Transcatheter aortic valve implantation (TAVI) evolved from an alternative to a primary therapy.
• Initial TAVI indications were based on high surgical risk.

Purpose of the Study:

• To review the evolution of TAVI and surgical valve replacement (SVR) indications.
• To discuss factors beyond surgical risk influencing treatment decisions.
• To highlight the shift towards a lifetime management approach for AS.

Main Methods:

• Literature review of clinical trials and guidelines.
• Analysis of evolving treatment paradigms for severe AS.
• Discussion of patient-specific factors in treatment selection.

Main Results:

• TAVI is now the main treatment for most severe AS patients, including low- and intermediate-risk groups.
• Clinical decision-making incorporates age, life expectancy, comorbidities, anatomy, and patient preference.
• A lifetime management strategy is now central to AS treatment.

Conclusions:

• TAVI indications have broadened considerably over two decades.
• Optimal AS treatment selection requires a comprehensive, individualized approach.
• Lifetime management is crucial for patients with severe aortic stenosis.