Expert panel explores TAVR’s present and future
Transcatheter aortic valve replacement (TAVR) continues to reshape healthcare, allowing a growing number of patients with severe aortic stenosis (AS) to receive the care they need without undergoing open surgery. It can be difficult to keep up with the field, however, with innovators introducing TAVR technologies and techniques seemingly all the time.
With all of that in mind, a “Beyond the Guideline” session about TAVR was held at the 2026 Cardiovascular Research Technologies (CRT) meeting in Washington, DC. The panel explored the current state of TAVR care in the world and raised several questions along the way.
Thomas Edward MacGillivray, MD, a cardiac surgeon with MedStar Health, and Ron Waksman, MD, an interventional cardiologist with MedStar Health, moderated the session. Six specialists from the United States and Germany participated as panelists:
• Holger Thiele, MD, Heart Center Leipzig, Germany
• Michael Joner, MD German Heart Centre Munich, Germany
• Howard C. Herrmann, MD Hospital of the University of Pennsylvania
• Hasan A. Jilaihawi, MD, Cedars Sinai Medical Center
• Gilbert Tang, MD, MSc, MBA, Mount Sinai Health System
• Isaac George, MD, Columbia Medical Center
Seeking to help disseminate knowledge about this topic to cardiologists and cardiac surgeons around the world, Cardiovascular Revascularization Medicine published key takeaways from the CRT 2026 panel July 29.[1]
“As the field continues to evolve, identifying where TAVR's potential can safely expand—and where the technology's limitations remain—is crucial,” wrote first author Edward Ha, MD, a researcher with MedStar Washington Hospital Center, and colleagues. “The relatively lower procedural cost and less invasive nature of TAVR changes the risk/benefit calculus compared to surgery, and with it, the range of indications to which TAVR may be applicable. At the same time, TAVR's inherent limitations leave important questions unanswered in patients with complex anatomies and pathologies.”
TAVR recommendations starting to converge
TAVR guidelines in both the United States and Europe support the use of TAVR to treat symptomatic severe AS. In fact, the authors wrote, the European guidelines seem to be shifting such that they are getting closer to the existing U.S. guidelines.
For now, though, the two sets are far from identical. For example, each takes its own approach to directing the use of hemodynamic flow status and ejection fraction as treatment modifiers. Further, the European guidelines emphasize age and de-emphasize risk when choosing between TAVR and surgical aortic valve replacement (SAVR).
Even so, it comes clear in both guidance documents that TAVR is now firmly established as a go-to treatment option for many patients.
Topics of interest that go ‘Beyond the Guidelines’
Asymptomatic severe AS. One key part of the group discussion was the treatment of asymptomatic severe AS, a topic getting considerable attention in recent months. Both U.S. and European guidelines view ejection fraction as a critical risk modifier in asymptomatic patients. In fact, the latest European guidance assigns a class IIA recommendation to treating patients with asymptomatic severe AS and an LVEF ≥50.
While there is still some resistance in the field to asymptomatic patients undergoing TAVR, things seem headed in that direction. The U.S. Food and Drug Administration already approved certain TAVR valves for asymptomatic patients, for example, and payment policies are under consideration in the United States that would ensure asymptomatic TAVR is covered by Medicare.
Bicuspid AS. The panel also reviewed the latest thoughts on treating patients with a bicuspid aortic valve (BAV). While these individuals were typically excluded from major clinical trials, and the early data found that they face an increased risk of residual aortic regurgitation, registry data has shown that they appear to benefit from TAVR just like other high-risk heart patients. Certain risks, however, still exist when treating a patient with a BAV.
“The presence of a calcified raphe and excessive leaflet calcification is associated with the highest risk of procedural complications and midterm mortality; the presence of either feature carries intermediate risk, while mild or no calcification carries the lowest risk,” the authors wrote. “Careful anatomic selection appears to be the key to success in bicuspid TAVR.”
More research is needed before any final recommendations can be made one way or the other, they note.
Redo TAVR. As TAVR continues to gain momentum as a treatment option in younger patients, redo TAVR is only going to grow more common.
This trend, the experts agreed, is associated with certain challenges for operators. There is a risk of under-expansion, for example, and predicting the position of the second TAVR valve during deployment can be difficult. One of the most nettlesome potential issues with redo TAVR is the risk of coronary obstruction. Valves are now being designed with coronary obstruction at top of mind, however, and researchers remain hard at work working to determine the optimal approach to these redo procedures. TAVR explant remains an option, of course, in situations where redo TAVR may not be possible.
When patients present with concomitant conditions. There are many other factors to consider when deciding to perform TAVR. What is the best approach, for example, when a patient requires TAVR and has a concomitant ascending aortic aneurysm? And what if a patient has multivalve disease?
The panel discussed these topics as well, highlighting the latest research in each area. One key point was that some patients may still just require TAVR alone, with care teams left to reassess once the procedure is complete. This is an especially crucial point to consider in those patients with multivalve disease.
“Transcatheter valve management strategies may be categorized into three main pathways: TAVR alone, a staged approach, and concomitant/hybrid interventions,” the authors wrote. “The conservative TAVR-alone approach is favored for mild-to-moderate secondary valve lesions. For patients with severe mitral regurgitation (MR) that does not improve post-TAVR, a staged approach is recommended, involving a secondary procedure like transcatheter edge-to-edge repair at least after 30 days from index TAVR.”
In lower surgical risk patients, they add, a heart team approach will determine whether surgery is the ideal management option, “given the ability to address all valvular lesions and atrial fibrillation to restore patients to sinus rhythm, especially in those with atrial secondary MR or tricuspid regurgitation.”
Heart teams remain ‘the cornerstone of care’
What researchers know about TAVR is still evolving, and fast, and there are still many unanswered questions. For now, the authors wrote, it is important for care teams to always communicate with one another.
“A heart team approach integrating individualized risk-benefit assessment remains the cornerstone of care for patients whose clinical presentations extend beyond the boundaries of current guideline recommendations,” the authors wrote.
There’s more in the full analysis. Click here to read it all, including details about how panel audience members voted on various TAVR-focused questions.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.