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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
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