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The following is a summary of “Transcatheter Aortic Valve Replacement Beyond Severe Aortic Stenosis: JACC State-of-the-Art Review,” published in the March 2025 issue of the Journal of the American College of Cardiology by Beerkens et al. 

Transcatheter aortic valve replacement (TAVR) has emerged as the preferred therapeutic approach for appropriately selected patients with symptomatic severe aortic stenosis (AS), offering a minimally invasive alternative to surgical aortic valve replacement. Advances in technology and procedural techniques have facilitated the expansion of TAVR indications beyond patients with traditional high- and intermediate-risk to include individuals with bicuspid aortic valve anatomy, small aortic annuli, and low-flow, low-gradient AS, as well as younger patients with fewer comorbidities. Additionally, there is growing interest in extending TAVR to asymptomatic severe and even moderate AS, as early intervention may mitigate the risk of progressive myocardial remodeling and long-term cardiac dysfunction. The development of dedicated transcatheter devices for native aortic regurgitation has yielded promising short-term results, further broadening the scope of patients who may benefit from TAVR. 

However, the increasing utilization of TAVR in younger populations raises concerns regarding long-term valve durability, the feasibility of future reinterventions, and the implications of lifelong management. Although valve-in-valve TAVR has demonstrated encouraging midterm outcomes in patients requiring redo interventions, questions remain regarding optimal patient selection, durability of bioprosthetic valves, and strategies for long-term care. 

In this review, researchers provide a comprehensive summary of the latest evidence surrounding TAVR expansion into these contemporary patient populations, highlighting both the potential benefits and the unresolved challenges associated with broadening the indications for this evolving procedure.

Source: sciencedirect.com/science/article/abs/pii/S0735109725000646