The continued evolution of transcatheter aortic valve implantation (TAVI) technology and the results of multiple randomized clinical trials (RCTs) have firmly established this approach as an alternative to surgical aortic valve replacement (SAVR) in the treatment of aortic stenosis in all risk groups. Deciding on TAVI or SAVR depends on patient-specific factors, including technical, procedure-specific contraindications and the balance between estimated life expectancy and anticipated prosthesis durability. These factors pertain to the decision between mechanical and biological prostheses, and if the choice is biological, between SAVR and TAVI. A strong emphasis is now placed on shared decision-making with the patient and involvement of the multidisciplinary heart team. For most patients younger than 65 years, SAVR is recommended, with mechanical valves favored in those younger than 50 years. For those older than 65 years, the perioperative risks of mortality and stroke are lower with transfemoral TAVI compared with SAVR, but the risks of paravalvular leak, a pacemaker requirement, and vascular complications are higher (Table).

经导管主动脉瓣植入术 (TAVI) 技术的持续发展和多项随机临床试验 (RCT) 的结果已牢固确立该方法可替代外科主动脉瓣置换术 (SAVR) 治疗所有风险人群的主动脉瓣狭窄。决定使用 TAVI 或 SAVR 取决于患者的具体因素，包括技术、特定程序的禁忌症以及估计预期寿命和预期假体耐用性之间的平衡。这些因素与机械和生物假体之间的决定有关，如果选择是生物的，则在 SAVR 和 TAVI 之间进行选择。现在非常强调与患者共同决策以及多学科心脏团队的参与。对于大多数 65 岁以下的患者，建议使用 SAVR，50 岁以下的人青睐机械瓣膜。对于 65 岁以上的患者，经股动脉 TAVI 的围手术期死亡率和卒中风险低于 SAVR，但瓣周漏、起搏器要求和血管并发症的风险较高（表）。