Challenges in the Lifetime Management of Patients with Aortic Stenosis

Despite an extensive body of literature, there are still many gaps in the evidence surrounding the lifetime management of aortic stenosis (AS) and upstream interventions to prevent or slow down the progression of the disease are yet to be developed.The contemporary shift from simple grading to a more outcome-related staging of AS has rendered the traditional belief that aortic valve intervention is only indicated in severe symptomatic AS obsolete and opened the debate on the optimal timing for intervention.Transcatheter aortic valve implantation (TAVI) has stood the test of time as a convenient, safe and effective treatment of AS across all risk categories.However, with the expansion of TAVI to younger patients with a longer life expectancy, there has been a gradual shift in focus from periprocedural outcomes to lifetime management, especially in patients who are likely to outlive their first valve prosthesis.In a standard scenario, when choosing the first valve, many actors come to the stage, including outcomes and challenges of repeated valve implantations.