TAVR in 2023: Who Should Not Get It?

Am J Cardiol. 2023 Apr 15:193:1-18. doi: 10.1016/j.amjcard.2023.01.040. Epub 2023 Feb 27.


Since the first transcatheter delivery of an aortic valve prosthesis was performed by Cribier et al in 2002, the picture of aortic stenosis (AS) therapeutics has changed dramatically. Initiated from an indication of inoperable to high surgical risk, extending to intermediate and low risk, transcatheter aortic valve replacement (TAVR) is now an approved treatment for patients with severe, symptomatic AS across all the risk categories. The current evidence supports TAVR as a frontline therapy for treating severe AS. The crucial question remains concerning the subset of patients who still are not ideal candidates for TAVR because of certain inherent anatomic, nonmodifiable, and procedure-specific factors. Therefore, in this study, we focus on these scenarios and reasons for referring selected patients for surgical aortic valve replacement in 2023.

Keywords: Aortic annulus; Bicuspid aortic valve; Severe aortic stenosis; Surgical aortic valve replacement; Transcatheter aortic valve replacement.

Publication types

  • Review

MeSH terms

  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / etiology
  • Aortic Valve Stenosis* / surgery
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Risk Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome