Who is the next for aortic valve implantation? Present and future indications

Abstract

Aortic valve stenosis (AS) represents the most prevalent valvular defect worldwide. It is a progressive disease with a long latency interval and a poor prognosis after symptoms present. According to current European Society of Cardiology guidelines, transcatheter aortic valve implantation (TAVI) is recommended in all patients with severe symptomatic AS and a predicted survival longer than one year, who are not suitable for surgical valve replacement. Despite these recommendations, several studies over the past few years suggest extending these indications towards lower risk AS populations. Otherwise, current available operative risk scores such as Society of Thoracic Surgeons score and EuroSCORE, may offer an incomplete risk assessment; in this setting, the Heart Team plays a crucial role in defining the most appropriate therapeutic strategy in patients with AS. In this review, we aim to discuss the current and future indications for TAVI, analyzing available literature according to patients' profile risk (high/mid/low risk) and other specific conditions (valve-in-valve, bicuspid valve and pure aortic regurgitation).