Comparison of Transcatheter Aortic Valve Implantation to Medical Therapy in Prohibitive-Risk Patients

Aortic stenosis is the most common primary valve disease needing surgical treatment in Europe and North America. The prevalence of this disease increases over years due to the ageing population. Age and comorbidities often represent an obstacle to surgical aortic valve replacement (AVR) for those patients considered at high and prohibitive risk. In this scenario, transcatheter aortic valve replacement (TAVR) has become an appealing therapeutic option for prohibitive-risk patients with severe symptomatic aortic stenosis who were previously only medically managed and considered unsuitable for AVR. However, the delicate balance between feasibility and appropriateness needs to be accurately defined. This chapter analyzes, basing on available literature, the outcome of such a challenging prohibitive population whether medically managed or undergoing TAVR. Recent findings from both controlled trials and registries suggest that more stringent guidelines for the older and frail population are emerging as a burning issue for health systems and caregivers.