Breaking the Barrier: The Benefits and Drawbacks of TAVI in Low-Surgical Risk Patients
|Take Home Messages|
Within two decades of its inception, transcatheter aortic valve implantation (TAVI) has emerged as a well-established treatment modality for patients diagnosed with severe aortic stenosis (AS), particularly in cases where conventional surgical aortic valve replacement (SA VR) poses intermediate or higher operative risk (1,2). Recent studies provide evidence indicating non-inferiority or even superiority of TAVI over SAVR in patients with low surgical risk, thus broadening the eligible patient population for TAVI (3,4). Despite encouraging 2-year outcomes (Table 1), the use of TAVI in younger, low surgical risk populations raises concerns regarding long-term complications which would have a greater impact on younger patients. Specifically, low-risk TAVI trials have demonstrated that certain complications are more frequent with TAVI when compared to SAVR, which could lead to undesirable cumulative effects with increased life expectancy. The landscape of TAVI has changed since previous reviews in 2019 (5,6) thus here I will revisit the literature and discuss these complications and other possible drawbacks of TAVI's widespread future use.