The current and future in transcatheter treatment of aortic stenosis: from the 'Beyond the Guidelines' session at...

The introduction of transcatheter aortic valve replacement (TAVR) over two decades ago has fundamentally reshaped the management and treatment landscape for the treatment of severe aortic stenosis by introducing a less invasive approach compared to a surgical aortic valve replacement (SAVR). The field continues to rapidly evolve as clinical studies expand the indications for TAVR across all surgical risk strata. However, it is unclear whether TAVR can be safely applied to patients with complex aortic valve and root pathologies as well as match the long-term durability demonstrated by SAVR. Thus, optimizing patient selection to maximize net clinical benefit, by defining the indications and limitations of TAVR, continue to be areas of active research and discourse. To this end, the annual 'Beyond the Guidelines' session at the 2026 Cardiovascular Research Technologies (CRT) convened an expert panel to highlight the current state of evidence, summarize the accumulated evidence in current domains of clinical equipoise where investigative efforts are focused, and identify key areas of clinical unmet need. This article summarizes the expert panel discussions of current evidence supporting the latest societal guidelines on management of severe aortic stenosis, the accumulation of investigative evidence in established clinical domains of equipoise including TAVR for aortic stenosis in asymptomatic patients; those with bicuspid aortic valves, treatment of transcatheter aortic valve failure, and expert opinions on emerging areas of unmet need where future investigative efforts may need to be focused.