Lifetime Management of Aortic Stenosis: Evolving Strategies and Personalized Decision-Making

Background: The landscape surrounding aortic stenosis continues to evolve as transcatheter aortic valve replacement (TAVR) is increasingly performed in younger and lower-risk patients who are likely to outlive their index prosthesis. With the rapid evolution in management of aortic stenosis, treatment has shifted from a single-procedure paradigm toward a lifetime strategy that anticipates future reinterventions. Therefore, having a foundational understanding and a thoughtful strategy when selecting the index procedure is paramount. Objectives: The objectives of this review article are to review contemporary evidence and provide a structured framework for lifetime management of severe AS. We focus on optimizing index valve selection and planning durable, safe pathways for subsequent reinterventions. Conclusions: Lifetime management of aortic stenosis requires a forward-looking, patient-centered Heart Team approach that extends beyond immediate procedural success. Strategic selection of the index valve intervention is crucial, and this is guided by anatomy, life expectancy, comorbidities, patient preference, and future reintervention feasibility. Together, these factors are essential to optimize long-term outcomes. As treatment paradigms continue to evolve, anticipatory planning and advanced simulation technologies will play an increasingly central role in delivering durable personalized care for patients with severe AS.