Predictors of long-term survival in patients undergoing TAVR: Recent advances. A narrative review

Transcatheter aortic valve replacement (TAVR)/intervention has fundamentally altered the management of severe aortic stenosis, expanding from inoperable patients to lower-risk populations and prompting a shift from a procedure-centric view to a lifelong management strategy. This paradigm shift necessitates a deeper understanding of factors predicting long-term survival beyond five years to guide personalized treatment decisions. This narrative review summarizes current evidence on predictors of long-term mortality following TAVR with a focus on novel predictors. Key patient-related factors include advanced age, impaired renal function, and subtle declines in ventricular function, such as reduced left ventricular global longitudinal strain and right ventricle-pulmonary artery uncoupling. Beyond traditional clinical assessments, emerging biomarkers like growth differentiation factor 15 and genetic markers of clonal hematopoiesis are showing prognostic potential. Procedural factors such as access route, paravalvular leak, and patient-prosthesis mismatch remain critical determinants of outcomes, with their long-term impact still under active investigation. Furthermore, valve-related characteristics, particularly the choice between self-expanding and balloon-expandable valves as well as supra-annular versus annular valves in specific anatomies, are increasingly recognized for their influence on valve hemodynamics and, potentially, long-term survival. As TAVR technology and patient longevity improve, future research must focus on integrating these multifaceted predictors to tailor device selection, ensuring optimal and durable outcomes for each patient.