Transcatheter Aortic Valve Replacement Within a Structured Secondary Prevention Framework in Cardiovascular Disease

Degenerative aortic stenosis represents a frequent and clinically significant manifestation of systemic cardiovascular disease, sharing common risk factors and pathophysiological mechanisms with atherosclerosis, including chronic inflammation, endothelial dysfunction, and calcific remodeling. Its frequent coexistence with comorbid conditions such as coronary artery disease and diabetes mellitus contributes to increased morbidity, mortality, and therapeutic complexity. In recent years, transcatheter aortic valve replacement has emerged as a cornerstone therapy for patients with severe symptomatic aortic stenosis across a wide spectrum of surgical risk, offering substantial improvements in hemodynamic performance, functional status, and quality of life. This review examines transcatheter aortic valve replacement within the context of secondary cardiovascular prevention. While the procedure effectively corrects valvular obstruction, it does not directly modify the systemic atherosclerotic and metabolic processes that drive long-term cardiovascular risk. Emphasis is placed on comprehensive preprocedural evaluation, including multimodality imaging with transthoracic echocardiography, cardiac magnetic resonance, computed tomography, and transesophageal echocardiography, which together support accurate phenotyping, risk stratification, and procedural planning as determinants of downstream outcomes. Beyond procedural success, transcatheter aortic valve replacement is associated with favorable effects on cardiovascular prognosis, including reductions in heart failure-related hospitalizations. However, as survival improves, residual cardiovascular risk increasingly reflects the impact of systemic comorbidities and myocardial vulnerability rather than valve-related pathology alone. This shift underscores the need for structured secondary prevention strategies following the intervention. Optimal long-term management therefore requires aggressive control of cardiovascular risk factors, guideline-directed medical therapy, individualized antithrombotic strategies, and structured follow-up integrating prosthetic valve surveillance with ongoing cardiovascular risk reduction. Transcatheter aortic valve replacement should be viewed not as a secondary prevention therapy in isolation, but as a pivotal structural intervention embedded within a broader, longitudinal cardiovascular prevention framework.