Transcatheter aortic valve replacement in heart failure

Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research. TAVR in heart failure. AS, aortic stenosis; AVG, aortic valve gradient; GDMT, guideline-directed medical therapy; HF, heart failure; LF LG, low flow low gradient; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; LVSD, left ventricular systolic dysfunction; NYHA, New York Heart Association; RCT, randomized controlled trial; RVD, right ventricular dysfunction; SAVR, surgical aortic valve replacement; SV, stroke volume; TAVR, transcatheter aortic valve replacement. image