Timing of transcatheter aortic valve implantation in patients with aortic stenosis.

Aortic stenosis is the most prevalent valvular heart disease in the Western world, affecting over 12% of individuals aged 75 years and older. The optimal timing of transcatheter aortic valve implantation or surgical aortic valve replacement remains one of the most debated topics in contemporary cardiology, particularly for asymptomatic patients with severe disease or symptomatic patients with moderate aortic stenosis. Whilst symptomatic severe aortic stenosis has established indications for intervention, the management of these other groups of patients requires careful consideration of disease progression, myocardial damage, procedural risks, and long-term outcomes. Recent randomised controlled trials have provided preliminary evidence regarding early intervention strategies. This review examines the current evidence base for the timing of aortic valve replacement, with a particular focus on transcatheter aortic valve implantation, and discusses the implications of recent trial data for clinical practice and guideline recommendations.