Advances in Aortic Valve Replacement: Current Techniques, Technology, and Long-Term Follow-Up

Dear Colleagues,

Aortic valve replacement (AVR) has rapidly evolved, with transcatheter aortic valve replacement (TAVR) now widely adopted across all surgical risk groups and, in many regions, surpassing surgical AVR (SAVR) in volume. While early and mid-term outcomes have been well established, the field is now entering a critical phase where long-term outcomes, durability, and lifetime management have become central to clinical decision-making. This shift is particularly relevant as AVR is increasingly performed in younger and lower-risk populations with longer life expectancy.

Despite encouraging data from landmark trials such as PARTNER 3, Evolut Low Risk, and NOTION, follow-up remains limited. Five-year outcomes demonstrate comparable rates of death and stroke between TAVR and SAVR, while 10-year data from NOTION suggest similar structural valve deterioration and clinical outcomes. However, robust data beyond 10 years remain scarce, especially for transcatheter valves, creating uncertainty regarding durability and long-term comparative effectiveness. Current guidelines highlight this gap, noting that while surgical bioprostheses have decades of follow-up, data on transcatheter valve durability remain limited to shorter time horizons. This evidence gap has major implications for younger patients, for whom the lifetime risk of reintervention, valve-in-valve strategies, and coronary access must be carefully considered.

The concept of lifetime management has therefore emerged as a central paradigm in the care of aortic stenosis. Initial valve choice must now account not only for procedural risk and short-term recovery but also for future interventions, cumulative risk, and long-term complications. Key unresolved issues include structural valve degeneration, need for reintervention, feasibility of repeat TAVR or surgical explantation, and risks such as stroke, conduction disturbances, and coronary obstruction. Concurrently, newer-generation valves and novel biomaterials are being developed to improve durability, optimize hemodynamics, and facilitate future interventions, though long-term validation is ongoing.

This Special Issue aims to present and disseminate the latest advances in long-term outcomes and lifetime management following aortic valve replacement. We consider contributions addressing long-term trial data, durability, reintervention strategies, and evolving technologies that influence outcomes beyond the early procedural period.

Topics of interest for publication include, but are not limited to, the following:

• Long-term outcomes from randomized trials and registries (≥5–10 years follow-up);
• Valve durability and structural valve degeneration;
• Lifetime management strategies and sequencing of interventions;
• Reintervention after AVR, including valve-in-valve approaches and surgical explantation;
• Stroke risk and long-term complications after TAVR and SAVR;
• Conduction disturbances post-TAVR, including LV versus RV pacing strategies.

By bringing together original research, reviews, and expert perspectives, this Special Issue aims to provide a focused, clinically relevant overview of long-term considerations in AVR and to guide clinical evidence-based, patient-centered care.

Dr. Dhan Bahadur Shrestha
Dr. Khagendra Dahal
Guest Editors

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