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The first aortic valve replacement (AVR) from a human patient performed in 1962 marked the beginning of an evidence-based journey of open-heart surgery for aortic valve stenosis (AVS). Surgical aortic valve replacement (SAVR) has long been the standard treatment to reduce symptoms and improve survival in patients with severe AVS through multiple trials, with an established durability beyond 10 years and low mortality rate in the absence of serious comorbidities.1 Nevertheless, over the last two decades, we have witnessed a rapidly evolving evidence basis for the treatment of AVS since the first human transcatheter aortic valve implantation (TAVI) by Alain Cribier in 2002.
TAVI has established itself as a data-driven preferred treatment option for patients deemed to be at excessive or high risk of conventional SAVR.2 Technological innovations in valve design, refinement in implantation techniques and increased operator experience, along with the evolving evidence basis, have contributed to the expansion of the therapeutic indication to include intermediate-risk and low-surgical risk patients.3 This evolution of practice is reflected in current guidelines; the 2021 European Guidelines on the Management of Valvular Heart Disease recommend TAVI over SAVR in older patients (≥75) or those with a high surgical risk. In contrast, SAVR is favoured in younger patients (<75) with low surgical risk. In other patients, SAVR or TAVI remain treatment options dependent on heart team evaluation.4 Similarly, the 2020 American Heart Association guidelines favour TAVI in patients ≥80 years or in younger patients with a life expectancy of less …
Twitter @valeriaparadies, @MMamas1973
Contributors VP wrote the first draft. MAM edited for significant intellectual content. Both authors approved the final draft.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.