Surgical Aortic Valve Replacement: Current Status and Future Perspectives in the Era of Catheter-Based Therapies

Aortic stenosis (AS) is the most prevalent valvular heart disease in the developed world. Over the past two decades, the treatment of AS has undergone a profound transformation with the introduction of transcatheter aortic valve replacement (TAVR). TAVR has evolved from being an alternative treatment for patients with a prohibitive risk for surgical aortic valve replacement (SAVR), to becoming the first-line therapy for low-surgical-risk patients over 75 years old. Recent data have shown a significant increase in TAVR procedures compared to SAVR, surpassing both isolated SAVR and all SAVR interventions in most registries worldwide. Nevertheless, SAVR remains a key option in clinical practice, especially for younger patients with a longer life expectancy, patients with a complex aortic anatomy unsuitable for TAVR, and patients needing additional surgical interventions. The aim of this review was to examine the current state and future perspectives of SAVR in the expanding era of transcatheter therapies. While TAVR is expected to expand further, SAVR will likely continue to play an important role in some clinical scenarios. A multidisciplinary approach by a “Heart Team” that considers specific clinical and anatomical factors is crucial for ensuring the best long-term outcome for each patient.