TAVR's Present and Future Explored at CRT 2026; CathSAP Update Adds Latest Data

An expert panel at the 2026 Cardiovascular Research Technologies (CRT) meeting in Washington, DC, explored the current state of transcatheter aortic valve replacement (TAVR) and raised questions about the technology's future. Key takeaways from the session were published in Cardiovascular Revascularization Medicine, while CathSAP's latest update incorporated new TAVR guidelines and trial data, including the FDA approval of TAVR for asymptomatic severe aortic stenosis.

TAVR guidelines in both the United States and Europe support the use of TAVR to treat symptomatic severe aortic stenosis (AS). The authors wrote that the European guidelines seem to be shifting closer to the existing U.S. guidelines, 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, and the European guidelines emphasize age and de-emphasize risk when choosing between TAVR and surgical aortic valve replacement (SAVR).

A 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, and the latest European guidance assigns a class IIA recommendation to treating patients with asymptomatic severe AS and an LVEF ≥50. The U.S. Food and Drug Administration already approved certain TAVR valves for asymptomatic patients, and payment policies are under consideration in the United States that would ensure asymptomatic TAVR is covered by Medicare.

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, registry data has shown that they appear to benefit from TAVR just like other high-risk heart patients. The authors wrote: '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.' More research is needed before any final recommendations can be made.

As TAVR continues to gain momentum as a treatment option in younger patients, redo TAVR is only going to grow more common. The experts agreed that this trend is associated with challenges for operators, including a risk of under-expansion and difficulty predicting the position of the second TAVR valve during deployment.

CathSAP's latest update delivers practice-relevant advances across interventional cardiology, led by major guideline updates including the 2025 Acute Coronary Syndromes Guidelines and the 2024 Lower Extremity Peripheral Artery Disease Guidelines. The update also features transformative structural heart disease data, including findings from the EARLY TAVR trial, the FDA approval of TAVR for asymptomatic severe aortic stenosis, and key evidence from EVOLVED, TAVR UNLOAD and ALIGN AR. It also includes the innovative SESAME technique and emerging data in right-sided valve disease from the TRAVEL II trial.