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<p>The evidence base for the treatment of aortic valve stenosis has seen numerous improvements in recent years. Current studies show that transcatheter aortic valve implantation (TAVI) is increasingly becoming an alternative to surgical aortic valve replacement, even for younger low-risk patients. The industry independent DEDICATE study demonstrated the noninferiority of the TAVI strategy, with lower rates of bleeding complications and reduced mortality, albeit with a&#xa0;higher incidence of new pacemaker implantations. Long-term studies, such as the NOTION study, found no significant differences between TAVI and surgical procedures in terms of clinically relevant endpoints after 10&#xa0;years and a&#xa0;superior valve durability for TAVI. The EARLY-TAVR study showed that an early intervention with TAVI can be beneficial even for asymptomatic patients with severe aortic valve stenosis, as nearly 50% of patients in the medication only group required valve replacement within 12&#xa0;months, often due to symptoms or a&#xa0;worsening left ventricular function. New randomized studies are also addressing the optimal approach for specific patient groups, such as women with a&#xa0;small aortic valve annulus or patients with concomitant coronary artery disease. Altogether, the current evidence confirms the growing importance of TAVI as a&#xa0;complementary strategy to surgical valve replacement across all risk groups. Age alone no longer seems to be a&#xa0;justified criterion for determining the treatment strategy based on the available data. Instead, the modern heart team should conduct a&#xa0;comprehensive evaluation that, in addition to age also considers comorbidities, anatomical conditions and risk factors for specific complications (e.g., pacemaker implantation). In addition to parameters that are decisive for an optimal acute outcome, all aspects that are relevant to long-term treatment management must also be considered when making decisions. These include, in particular, the coronary artery access and the feasibility of repeat valve replacement in cases of valve degeneration. Only a&#xa0;forward-thinking approach to the treatment of aortic valve stenosis enables the optimal patient-specific utilization of the respective advantages of both TAVI and surgical valve replacement.</p>

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Aortenklappenerkrankungen – Wann katheterbasierte Therapie?

  • 期刊论文

  • 发表日期：

    2025年3月7日

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  • Konstantin Stark,
  • Steffen Massberg

摘要

The evidence base for the treatment of aortic valve stenosis has seen numerous improvements in recent years. Current studies show that transcatheter aortic valve implantation (TAVI) is increasingly becoming an alternative to surgical aortic valve replacement, even for younger low-risk patients. The industry independent DEDICATE study demonstrated the noninferiority of the TAVI strategy, with lower rates of bleeding complications and reduced mortality, albeit with a higher incidence of new pacemaker implantations. Long-term studies, such as the NOTION study, found no significant differences between TAVI and surgical procedures in terms of clinically relevant endpoints after 10 years and a superior valve durability for TAVI. The EARLY-TAVR study showed that an early intervention with TAVI can be beneficial even for asymptomatic patients with severe aortic valve stenosis, as nearly 50% of patients in the medication only group required valve replacement within 12 months, often due to symptoms or a worsening left ventricular function. New randomized studies are also addressing the optimal approach for specific patient groups, such as women with a small aortic valve annulus or patients with concomitant coronary artery disease. Altogether, the current evidence confirms the growing importance of TAVI as a complementary strategy to surgical valve replacement across all risk groups. Age alone no longer seems to be a justified criterion for determining the treatment strategy based on the available data. Instead, the modern heart team should conduct a comprehensive evaluation that, in addition to age also considers comorbidities, anatomical conditions and risk factors for specific complications (e.g., pacemaker implantation). In addition to parameters that are decisive for an optimal acute outcome, all aspects that are relevant to long-term treatment management must also be considered when making decisions. These include, in particular, the coronary artery access and the feasibility of repeat valve replacement in cases of valve degeneration. Only a forward-thinking approach to the treatment of aortic valve stenosis enables the optimal patient-specific utilization of the respective advantages of both TAVI and surgical valve replacement.