SCAI 2026 The End of Watchful Waiting: Long Term TAVR Evidence and a New Proactive Paradigm-Moving from Watchful Waiting to Proactive Management of Aortic Stenosis, Dr. Szerlip

Moving from Watchful Waiting to Proactive Management of Aortic Stenosis, Dr. Szerlip

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Video Summary

In May 2025, FDA approval expanded Sapien 3 use for asymptomatic severe aortic stenosis, but CMS coverage still limits payment to symptomatic cases. A large randomized trial of early TAVR in asymptomatic severe AS showed a significant reduction in the composite of death, stroke, and unplanned cardiovascular hospitalization, mainly driven by fewer strokes and hospitalizations, not lower mortality. Many patients who waited developed advanced “acute valve syndrome” and more cardiac damage, which worsened outcomes and costs. The takeaway: earlier referral and evaluation for AVR/TAVR may prevent deterioration, reduce hospitalizations, and improve clinical and economic outcomes.

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Keywords

Sapien 3

asymptomatic severe aortic stenosis

TAVR

aortic

TAVI

early valve replacement

acute valve syndrome