New Horizons in Transcatheter Aortic Valve Replacement: Expectations and Preparations

Transcatheter aortic valve replacement (TAVR) has transformed the management of severe aortic stenosis and is now widely used across a broad spectrum of surgical risk. With expanding indications and increasing use in younger patients, contemporary practice increasingly emphasizes lifetime management of aortic valve disease, a shift further supported by recent developments including findings from the EARLY TAVR trial and the May 2025 U.S. Food and Drug Administration approval of TAVR for asymptomatic severe aortic stenosis. This narrative review summarizes recent developments in TAVR, including advances in device technology, procedural techniques, and patient selection. Focus is placed on the importance of optimal first valve selection, prevention of prosthesis-patient mismatch (PPM), and planning for future reintervention such as valve-in-valve (ViV) TAVR. Emerging procedural strategies including bioprosthetic valve fracture and leaflet modification techniques have expanded treatment options for patients at risk of elevated gradients or coronary obstruction. The review also highlights evolving approaches to TAVR in complex clinical scenarios and discusses future directions in device design and imaging-based procedural planning. As TAVR continues to evolve, careful procedural planning and multidisciplinary heart team collaboration remain essential to optimizing long-term outcomes.