It happened tomorrow—transcatheter treatments in the lifetime management of aortic valve diseases

Transcatheter aortic valve replacement (TAVR) has evolved into a prevalent treatment for severe aortic stenosis, extending beyond high-risk patients to include those at intermediate and low surgical risk. This shift is evident in the escalating number of TAVR procedures, surpassing both isolated surgical aortic valve replacement (SAVR) and combined procedures in recent years. While surgical bioprostheses have historically demonstrated remarkable durability, the landscape is evolving with TAVR options. When evaluating the durability of aortic bioprostheses, challenges arise from variations in defining and reporting structural valve degeneration (SVD) with lack of balanced, controlled, real-world data providing solid evidence. In addressing SVD, reintervention strategies differ for degenerated SAVR and TAVR. Valve-in-valve (ViV) procedures dominate for SAVR, with a preference for their lower procedural risk. Redo SAVR remains a viable option, but with increased short-term mortality. In contrast, degenerated TAVR may involve transcatheter-in-transcatheter strategies or surgical explantation followed by SAVR, each posing distinct challenges and considerations. In the realm of infective endocarditis (IE), challenges arise in diagnosing and managing post-TAVR cases. Despite comparable incidence rates between TAVR and SAVR, TAVR presents unique complexities, including atypical clinical presentations and vegetations located outside the valve. Outcomes in patients with IE in TAVR are notably poorer than in SAVR, raising questions about optimal management strategies. Considering the increasing adoption of transcatheter solutions in younger, lower-risk patients, the choice between surgical and transcatheter options demands individualized considerations. As structural valve deterioration and IE emerge as common causes for reoperations, a comprehensive understanding of long-term outcomes based on real-world propensity score-matched data is essential for informed decision-making in the evolving landscape of aortic valve disease management.