Shifting paradigms for treatment of symptomatic aortic stenosis in lower risk populations: role of a newer generation balloonexpandable transcatheter aortic valve implantation device

Over the last decade, transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for patients with symptomatic severe aortic valve stenosis at a prohibitive or high risk for surgical valve replacement. Since its introduction in 2002 and establishment of the retrograde transfemoral access route in 2005, TAVI procedures underwent several refinements (1-3). Improved prosthesis design and delivery systems, as well as the systematic use of multimodality imaging for accurate patient selection and valve positioning have significantly improved the efficacy and safety of TAVI devices over the last years. Although TAVI is currently approved for the treatment of inoperable or high surgical risk patients with severe symptomatic AS, increased operator experience and improved valve systems have expanded the use of TAVI towards patients with intermediate or lower risk (4-6). However, so far, because of the lack of large scale and randomized data, the expansion of the use of TAVI to lower risk populations warranted careful individual clinical evaluation and decision-making.