TAVI in low‑risk severe aortic stenosis: evidence, controversies and lifetime treatment strategy

Transcatheter aortic valve implantation (TAVI) has expanded from a treatment for inoperable and high-risk aortic stenosis (AS) to an established therapeutic option for selected patients at low surgical risk; this review focuses on the outcomes of major trials comparing TAVI to traditional surgical aortic valve replacement (SAVR), highlighting outcomes and potential complications when considering lifetime valve management when moving into the younger population. A literature search of PubMed using terms such as ‘transcatheter aortic valve replacement’ and ‘low surgical risk’ were used to identify relevant publications from within the last 10 years. Recent randomized trials and follow-up studies suggest that, in appropriately selected low-risk patients, TAVI and SAVR provide broadly comparable mid-term outcomes for cardiovascular mortality, stroke and valve reintervention. However, important differences remain. TAVI is consistently associated with lower rates of new-onset atrial fibrillation but higher rates of permanent pacemaker implantation and paravalvular aortic regurgitation. As TAVI moves into younger and asymptomatic populations, unresolved questions remain around valve durability, coronary access, redo strategies and lifetime valve management, highlighting the central role of multidisciplinary heart-team assessment in selecting the optimal lifetime therapeutic strategy.