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Verolino et al. Vessel Plus 2018;2:17                                       Vessel Plus
               DOI: 10.20517/2574-1209.2018.32




               Review                                                                        Open Access


               Who is the next for aortic valve implantation?
               Present and future indications


               Giuseppe Verolino, Alessia Delli Veneri, Myriam Carpenito, Francesco Piccirillo, Leonardo Aurino,
               Annunziata Nusca

               Department of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome 00128, Italy.
               Correspondence to: Dr. Annunziata Nusca, Unit of Cardiovascular Science, Campus Bio-Medico University of Rome, Via Alvaro
               del Portillo 200, Rome 00128, Italy. E-mail: a.nusca@unicampus.it
               How to cite this article: Verolino G, Delli Veneri A, Carpenito M, Piccirillo F, Aurino L, Nusca A. Who is the next for aortic valve
               implantation? Present and future indications. Vessel Plus 2018;2:17. http://dx.doi.org/10.20517/2574-1209.2018.32

               Received: 14 May 2018    First Decision: 5 Jul 2018    Revised: 14 Jul 2018    Accepted: 19 Jul 2018    Published: 2 Aug 2018
               Science Editor: Cristiano Spadaccio, Mario F. L. Gaudino    Copy Editor: Jun-Yao Li    Production Editor: Huan-Liang Wu



               Abstract
               Aortic valve stenosis (AS) represents the most prevalent valvular defect worldwide. It is a progressive disease with a
               long latency interval and a poor prognosis after symptoms present. According to current European Society of Cardiology
               guidelines, transcatheter aortic valve implantation (TAVI) is recommended in all patients with severe symptomatic
               AS and a predicted survival longer than one year, who are not suitable for surgical valve replacement. Despite these
               recommendations, several studies over the past few years suggest extending these indications towards lower risk
               AS populations. Otherwise, current available operative risk scores such as Society of Thoracic Surgeons score and
               EuroSCORE, may offer an incomplete risk assessment; in this setting, the Heart Team plays a crucial role in defining
               the most appropriate therapeutic strategy in patients with AS. In this review, we aim to discuss the current and future
               indications for TAVI, analyzing available literature according to patients’ profile risk (high/mid/low risk) and other
               specific conditions (valve-in-valve, bicuspid valve and pure aortic regurgitation).


               Keywords: Aortic valve implantation, aortic stenosis, structural valve intervention, bicuspid valve, valve-in-valve




               INTRODUCTION
               Aortic valve stenosis (AS) is the most prevalent valvular defect worldwide. It mainly affects elderly patients;
               it is a progressive disease with a long latency phase that, however, has a poor prognosis after symptoms of
               dyspnoea, angina or syncope occur. Despite significant strides in medical therapy for several other cardio-
               vascular pathological conditions, little progress has been made in medical therapy for AS. Observational
               studies demonstrated a mortality rate of 75% in patients with AS within 3 years of the symptom onset unless


                           © The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
                           International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
                sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
                as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
                and indicate if changes were made.


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