Redefining Aortic Valve Replacement: The Transition from Open Surgery to Transcatheter Innovation

Aortic valve replacement (AVR) has evolved dramatically, transitioning from open surgery to minimally invasive and transcatheter approaches. This review examines the historical and technological advancements in AVR, focusing on the evolution of mechanical and bioprosthetic valves, valve-sparing techniques, and the Ross procedure. Mechanical valves offer superior durability but require lifelong anticoagulation, while bioprosthetic valves avoid this need at the expense of long-term durability. Transcatheter aortic valve replacement (TAVR), originally reserved for high-risk patients, is now used across all risk profiles due to growing evidence of safety and efficacy from major trials like PARTNER and Core Valve. Despite its benefits, TAVR presents some challenges, including paravalvular leak, pacemaker implantation, and uncertain long-term durability, especially in younger patients. Valve-in-valve techniques, novel valve designs, and anti-calcification treatments offer promising solutions. Looking forward, the integration of artificial intelligence and personalized procedural planning will play a key role in optimizing outcomes. As AVR technology advances, careful patient selection and a multidisciplinary approach remain essential to guiding individualized treatment decisions.