Expanding Indications for Transcatheter Aortic Valve Implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) stands at the forefront of structural heart interventions, offering a minimally invasive alternative to surgical valve replacement in the treatment of severe aortic stenosis (AS). Over the past decade, TAVI has rapidly evolved, informed by technological advances, expanding operator skillsets, and an accumulating body of long-term clinical data. As eligibility criteria broaden, TAVI is now routinely applied across varying risk profiles, with exploratory use in lower-risk and younger populations, complex anatomies such as bicuspid valves, and novel indications including pure native aortic regurgitation. These shifts are redefining both clinical practice and ongoing debates regarding patient selection, procedural planning, and long-term outcomes.Despite significant progress, considerable uncertainties remain. The durability of transcatheter heart valves (THVs) in younger or low-risk patients is not fully established, and optimal strategies for managing bicuspid aortic valve disease, pure aortic regurgitation, and valve-in-valve (ViV) scenarios require further evidence. Additionally, expanding TAVI indications introduce new procedural challenges, such as maintaining coronary access, ViV feasibility, managing conduction disturbances, and facilitating repeat interventions. Advances in multimodality imaging, pre-procedural planning, artificial intelligence, and computational modeling promise a more tailored approach to therapy, yet the standardization and systematic integration of these innovations into routine practice are lagging. Defining evidence-based boundaries for TAVI candidacy and harmonizing protocols remain pressing needs as the field moves forward.This Research Topic aims to consolidate state-of-the-art evidence and foster interdisciplinary dialogue addressing the ongoing expansion of TAVI indications. By bringing together perspectives from clinical trials, real-world registry data, and translational research, the objective is to clarify patient selection criteria, refine procedural strategies, and chart optimal long-term management pathways. In doing so, the Research Topic seeks to shape best practices and guide the evolution of transcatheter therapy for the entire spectrum of aortic valve disease.The scope of this Research Topic encompasses both established and emerging clinical applications of TAVI, while focusing on the unresolved questions and future challenges that accompany expanded indications. Submissions should address the boundaries of candidacy, technical innovation, and multidisciplinary pathways.To gather further insights in these evolving areas, we welcome articles addressing, but not limited to, the following themes:• TAVI in low risk and younger patients: durability, lifetime management concepts, and strategies for preserving options for future interventions• Management of bicuspid aortic valve disease, with emphasis on anatomical assessment, device selection and procedural adaptations• TAVI for pure native aortic regurgitation and non calcific lesions: device innovation, anchoring challenges, and early to mid term outcomes• Valve in valve considerations within lifetime TAVI management: impact on index TAVI strategy, prosthesis choice, hemodynamics, and preservation of coronary access• Role of advanced imaging, artificial intelligence, and computational modeling in patient selection, procedural planning and follow-up• Multidisciplinary heart team models and standardized care pathways for patients considered for TAVI across risk strataAppendix: Article types welcomed include original research, methodology and consensus statements, reviews and mini-reviews, brief reports, technical and procedural planning reports, hypothesis-generating studies, and structured case series with hemodynamic and imaging correlations. Topic editors: Francesco Bedogni, Luca Testa, Antonio Sisinni Source: https://www.frontiersin.org/research-topics/76560/expanding-indications-for-transcatheter-aortic-valve-implantation-tavi