Clinical practice update: Who should be referred for transcatheter aortic valve replacement in 2017?

Transcatheter aortic valve replacement (TAVR) was initially envisioned as a less invasive option for patients with severe symptomatic aortic stenosis (AS) either not candidates or very high-risk candidates for surgical aortic valve replacement (SAVR). Based on data from the original Placement of Aortic Transcatheter Valves (PARTNER) trial and CoreValve® US Pivotal trials, TAVR is now approved and accepted in the treatment for severe symptomatic AS in extreme-, high-, and intermediate-risk patients. Thus far, the randomized controlled trial data for TAVR have been non-inferior or even superior to both medical therapy and SAVR. Given all the data, the logical next step is to study low-risk patient groups. Anecdotal and non-randomized data have been conflicting when comparing TAVR with SAVR in low-risk patients. Two low-risk randomized trials have started in the US, and ultimately, these trials will determine the feasibility of TAVR as an acceptable alternative to SAVR in low-risk patients with severe AS. Thus, in 2017, any patient with AS should be referred to a multidisciplinary valve team to be evaluated for TAVR, SAVR, or nothing, depending on risk and availability of ongoing clinical trials.