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Page 6 of 7 D’Abramo et al. Vessel Plus 2019;3:4 I http://dx.doi.org/10.20517/2574-1209.2018.41

including the surgical risk, patient frailty, comorbidities and also patient preferences. Since 2012, TAVR
indications have been extended into groups of patients who are at intermediate to high risk; TAVR has also
become the alternative to reoperation for those with bioprosthetic aortic valve degeneration. There are still
few data on TAVI for patients < 75 years of age and for surgical low-risk patients, in whom SAVR remains
the preferred approach since long-term durability data for TAVI prosthetic valves are still lacking. Moreover,
younger patients often carry a bicuspid valve disease and this anatomic pattern may affect the results of
TAVI. The past above cited trials excluded bicuspid valve patients. Surgical approach still plays a crucial role
in all the combined procedures as concomitant severe coronary artery disease, concomitant ascending aorta
disease or concomitant mitral and tricuspid valve disease. On the other side, longer follow up for both TAVI
and RD-AVR are going to be needed, not only for the effective durability, but to clear risk of paravalvular
leaks and pacemaker requirement, since they are likely to have greatest impact on low-risk and younger
populations on life expectancy and they are currently being investigated in randomized trials. Another open
issue is represented by anticoagulation regimen, since no specific recommendations exist on it and no data
are available on the risk of thrombus formation because of the stent frame and leaflet designs.

In the end, the approval of a TAVR valve for lower STS SAVR risk population does not mean, by now, that
TAVR is going to be the chosen procedure for any patient but this would certainly promote and encourage
the scientific debate and future researches.

DECLARATIONS
Authors’ contributions
All authors contributed equally.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
1. Bonow RO, Greenland P. Population-wide trends in aortic stenosis incidence and outcomes. Circulation 2015;131:969-71.
2. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, et al. Percutaneous transcatheter implantation of an aortica valve prosthesis
for calcific aortic stenosis: first human case description. Circulation 2002;106:3006-8.
3. Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, et al. Registry of trancatheter aortic valve implantation in high-risk
patients. N Eng J Med 2012;366:1705-15.
4. Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European
Outcome (SOURCE) Registry. A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve.
Circulation 2010;122:62-9.