New ESC/EACTS guidelines for the management of aortic valve disease: key takeaways and implications of long-term TAVR results based on recent explant and redo-TAVR registry outcomes

Background The 2025 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines for valvular heart disease represent a pivotal update, emphasizing earlier intervention for aortic stenosis (AS) and broader indications for transcatheter aortic valve replacement (TAVR). These changes are driven by randomized trial data demonstrating TAVR’s safety in lower-risk patients. However, as TAVR expands to younger cohorts, long-term durability remains a concern. Main body This narrative review examines key guideline updates for aortic valve disease, focusing on aortic stenosis (AS) and aortic regurgitation (AR), and integrates insights from recent registries (2020–2025) on TAVR explantation and redo-TAVR outcomes. Data from the EXPLANT-TAVR, EXPLANTORREDO-TAVR and FRANCE 2/FRANCE TAVI registries reveal reintervention rates of 0.3–1.7% at 8 years, with redo-TAVR offering superior short-term survival (30-day mortality 1.5–6.2%) compared to explantation (11.9–13.6%). Structural valve deterioration (SVD), leaflet thrombosis, and endocarditis predominate failure causes, underscoring the need for lifetime management strategies. Conclusion Implications include refined patient selection, enhanced imaging surveillance, and Heart Team-driven decisions to balance procedural benefits against reintervention risks.