Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis: A Review and Special Considerations

Abstract

Introduction

Severe aortic stenosis is a prevalent and life-threatening disease among older adults. Transcatheter aortic valve replacement (TAVR) has transformed management across all surgical-risk categories, supported by clinical trial data and guideline recommendations. This review aims to summarize current indications, pre-procedural evaluation, and clinical outcomes of TAVR, and to highlight special considerations in access disparities, high-risk comorbid populations, antiplatelet strategies, and vascular complications.

Methods

This narrative review synthesizes guideline documents, landmark randomized trials, and selected meta-analyses published between 2010 and 2025. Additional focused evidence from four retrospective cohort studies was used to illustrate issues in geographic access, chronic obstructive pulmonary disease (COPD), dual antiplatelet therapy (DAPT), and vascular access complications.

Results

Guideline-directed criteria increasingly support TAVR across age and surgical-risk groups, with transfemoral access demonstrating the most favorable outcomes. Randomized trials consistently show comparable survival between TAVR and surgical aortic valve replacement (SAVR), with faster early recovery and improved early quality-of-life metrics. Complication profiles differ: TAVR reduces bleeding and atrial fibrillation but increases vascular injury, conduction disturbances, and paravalvular regurgitation. Special populations—including those with advanced COPD or remote geographic residence—derive meaningful benefit. DAPT before TAVR increases bleeding and may worsen survival, whereas vascular complications significantly affect early outcomes and are strongly predicted by anatomical factors such as sheath-to-femoral artery ratio.

Conclusions

TAVR provides excellent short- and mid-term outcomes for appropriately selected patients. Continued attention to anatomical planning, pre-procedural optimization, and equitable access, along with long-term surveillance of valve durability, will shape future patient selection and procedural refinement.