Transcatheter Aortic Valve Implantation Indications and Patient Selection.

Abstract

Transcatheter aortic valve implantation (TAVI) has evolved from an alternative therapy for high-surgical risk patients with symptomatic severe aortic stenosis (AS) into the main treatment modality for most patients with severe AS. The indication for TAVI was initially based mainly on surgical risk profiles, but following positive trial results in intermediate- and low-risk patients, clinical decision pathways regarding the optimal treatment modality for AS patients, either TAVI or surgical valve replacement, changed considerably and a lifetime management approach incorporating several other additional patient characteristics evolved. This review aims to elucidate the evolution of TAVI and surgical valve replacement indications over the past two decades. Relevant clinical aspects beyond surgical risk including age, life expectancy, comorbidities, aortic anatomy and patient preference influencing decision-making regarding the modality of intervention in patients with severe AS, will be discussed in the context of lifetime management of AS.