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Published on: December 11, 2017
Heart Failure Pharmacotherapy Across the Transcatheter Aortic Valve Replacement Continuum
Takayuki Onishi1, Gilbert H L Tang2, Andy Moyal3
1Mount Sinai Fuster Heart Hospital, New York, New York.
Journal of Cardiac Failure
|July 4, 2026
Summary
Guideline-directed medical therapy (GDMT) for heart failure should be continued and optimized after transcatheter aortic valve replacement (TAVR). Early use of renin-angiotensin system inhibitors (RASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) shows the most benefit.
Area of Science:
- Cardiology and Cardiovascular Medicine
- Heart Failure Management
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common treatment for severe symptomatic aortic stenosis.
- Heart failure often persists post-TAVR due to incomplete reversal of myocardial remodeling and diastolic dysfunction.
- TAVR addresses valvular afterload but not the underlying myocardial disease.
Purpose of the Study:
- To review current evidence on guideline-directed medical therapy (GDMT) for heart failure across the TAVR continuum.
- To propose a framework for optimizing GDMT use in pre-, peri-, and post-TAVR phases.
- To identify priorities for future research in TAVR pharmacotherapy.
Main Methods:
- Review of available evidence on the safety, efficacy, and clinical outcomes of GDMT drug classes in TAVR populations.
- Integration of data supporting continuation and early optimization of GDMT.
- Analysis of evidence for renin-angiotensin system inhibitors (RASi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), mineralocorticoid receptor antagonists (MRAs), and beta-blockers (BBs).
Main Results:
- Accumulating data support continuing and optimizing GDMT across the TAVR continuum.
- Renin-angiotensin system inhibitors (RASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) show the most consistent benefit.
- Evidence for GDMT in TAVR populations is largely observational and heterogeneous.
Conclusions:
- Post-TAVR heart failure management requires continued GDMT, tailored to the patient's heart failure phenotype.
- Optimal timing, patient selection, and class-specific effects of GDMT require further investigation.
- Randomized trials are essential to define optimal GDMT implementation strategies post-TAVR.
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