ARTICLE IN PRESS JID: TCM [m5G;October 18, 2020;3:3] Trends in Cardiovascular Medicine xxx (xxxx) xxx Contents lists available at ScienceDirect Trends in Cardiovascular Medicine journal homepage: www.elsevier.com/locate/tcm Asymptomatic severe aortic stenosis, bicuspid aortic valves and moderate aortic stenosis in heart failure: New indications for transcatheter aortic valve implantation ✩,✩✩,★,★★ Michel Pompeu B.O. Sá a,1 , Matheus Simonato b,1 , Jef Van den Eynde c,∗ , Luiz Rafael P. Cavalcanti a , Leonardo Roever d , Gianluigi Bisleri e , Aleksander Dokollari f , Danny Dvir g , Konstantin Zhigalov h , Arjang Ruhparwar h , Alexander Weymann h a Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco – PROCAPE, University of Pernambuco, Pernambuco, Brazil b Division of Cardiac Surgery, Escola Paulista de Medicina – UNIFESP, São Paulo, Brazil c Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium d Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Brazil e Division of Cardiac Surgery, Queen’s University, Toronto, Canada f Division of Cardiac Surgery, University of Toronto, Toronto, Canada g Division of Cardiology, University of Washington, Washington, United States of America h Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany a r t i c l e i n f o Keywords: Aortic stenosis Aortic valve TAVI Bicuspid aortic valve Heart failure a b s t r a c t Aortic stenosis (AS) remains one of the most common valvular heart diseases, with enormous impact on patient survival. Over the past years, transcatheter aortic valve implantation (TAVI) has become a reality worldwide, offering a less invasive method to treat AS. Apart from the classical indications for aortic valve disease, recent studies tried to address unanswered questions for TAVI – asymptomatic severe AS, bicuspid aortic valves and moderate AS in patients with heart failure. This review discusses the rationale of those possible indications, pitfalls and current evidence in the medical literature. © 2020 Elsevier Inc. All rights reserved. Introduction Aortic stenosis (AS) is one of the most common acquired car- diac valvular diseases, with a major impact on patient survival and quality of life. It is an age-related disease with prevalence around 3% in patients older than 75 years worldwide, accounting for mil- lions of deaths per year [1,2]. Over the last years, we have witnessed the evolution of tran- scatheter technologies [3] with steadily improving outcomes. The indications for TAVI have expanded from inoperable to high risk to now include even those with low surgical risk [4], in addition to valve-in-valve (ViV) procedures for failed prior bioprosthetic valves [5]. The objective of this review is to summarize currently available ✩ Disclosures ✩✩ Gianluigi Bisleri is speaker for Medtronic and Livanova. ★ Danny Dvir is consultant for Edwards Lifesciences. ★★ All other authors have no conflict of interest. ∗ Corresponding author. E-mail address: jef.vandeneynde@student.kuleuven.be (J. Van den Eynde). 1 Both first authors made an equal contribution to the manuscript. evidence and to describe new trials and studies that may, in the near future, expand TAVI indications to asymptomatic severe AS, AS in bicuspid aortic valves and moderate AS associated to heart failure (HF). Search strategy and selection criteria We identified references for this review by searches of PubMed for articles published between Jan 1, 1980, and May 1, 2020. We also used references from the relevant articles identified via these searches. We used the search items “aortic stenosis”, “aortic valve”, “transcatheter aortic valve implantation”, “bicuspid aortic valve”, “heart failure”, and “treatment”. We restricted the search to articles published in English. We generated the final reference list based on relevance to the topics covered in this review. Asymptomatic severe aortic stenosis Natural history of asymptomatic severe aortic stenosis It is estimated that 50% of patients report no symptoms [6]. In a retrospective analysis of the CURRENT AS Registry including 1,517 https://doi.org/10.1016/j.tcm.2020.10.002 1050-1738/© 2020 Elsevier Inc. All rights reserved. Please cite this article as: M.P.B.O. Sá, M. Simonato, J. Van den Eynde et al., Asymptomatic severe aortic stenosis, bicuspid aortic valves and moderate aortic stenosis in heart failure: New indications for transcatheter aortic valve implantation, Trends in Cardiovascular Medicine, https://doi.org/10.1016/j.tcm.2020.10.002