Moderate aortic stenosis: The next frontier of transcatheter aortic valve implantation?

Alexis Théron, Julien Ternacle, Philippe Pibarot

Aortic stenosis (AS) is the most common valvular heart disease, leading to surgery or transcatheter intervention in developed countries, and its prevalence is increasing due to aging of the population [1]. The negative impact of severe AS on clinical outcomes and survival has been well established for several decades. However, there is a growing body of evidence suggesting that moderate AS is not benign and is associated with an increased risk of adverse outcomes
and reduced survival [2].

Aortic valve replacement (AVR), whether by surgical intervention or transcatheter aortic valve implantation (TAVI), is currently the only treatment available for AS. Current guidelines [3,4] recommend AVR (Class I indication) for patients with severe symptomatic AS or those with left ventricular ejection fraction (LVEF) < 50% in the absence of symptoms. For moderate AS, AVR is recommended (Class IIb indication) only in patients undergoing a coronary artery bypass graft or intervention on the ascending aorta or another valve [3,4]. This recommendation is mainly driven by the risk of a redo surgery in the short term, because of progression to severe AS.