Great Debate: Surgical Aortic Valve Replacement Is First Choice for Aortic Stenosis in Patients With a Life Expectancy Beyond 5 Years

This special “Great Debate” article discusses whether surgical aortic valve replacement (SAVR) should remain the first choice for aortic stenosis in patients with a life expectancy beyond five years. The pro side emphasizes the scarcity of data beyond five years, conflicting registry outcomes, higher transcatheter aortic valve implantation (TAVI) rates of pacemaker implantation, paravalvular regurgitation, stroke after one year, early valve thrombosis, reintervention, and uncertain long-term durability, especially in younger or bicuspid patients. The contra side argues that randomized trials show comparable SAVR and TAVI outcomes at five to seven years, with 10-year NOTION data showing similar mortality, stroke, or myocardial infarction, and that treatment should be individualized. The authors conclude that Heart Team assessment and shared decision-making should guide SAVR or TAVI selection.