Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients

Aortic stenosis (AS) is the most common cardiac valve disease in developed countries. Transcatheter aortic valve replacement (TAVR) for the treatment of severe symptomatic AS is an accepted therapy option for elderly patients with symptomatic severe AS. Nowadays, TAVR has revolutionized the treatment of AS with an exponential growth worldwide. Both the development of new generation valves and the experience of the operating teams have contributed significantly to decrease the complications rate after TAVR. Several randomized trials have reported similar short- and mid-term results, and even better than surgical aortic valve replacement (SAVR) in patients with high- or intermediate-risk. In addition, two comparison trials in low-risk patients have reported promising results. Therefore, in the future TAVR indications will expand, treating younger and younger patients, with less comorbidities and lower risk. However, the long-term durability of percutaneous prostheses is a matter of debate. The aim of this manuscript is to review available data that support to treat AS in low-risk patients and provide our perspective on the topic.