Transcatheter Aortic Valve Implantation (TAVI) In Marfan Syndrome with Critical Aortopathy: Safety and Feasibility in the Setting of Dilated Aortic Annuli

Marfan syndrome (MFS) is a hereditary connective tissue disorder characterized by cardiovascular manifestations, including aortic root dilation, valvular insufficiency, and an increased risk of aortic dissection. While surgical aortic valve replacement (SAVR) with root reconstruction remains the gold standard for severe aortic valve pathology in MFS, transcatheter aortic valve implantation (TAVI) has emerged as a potential alternative in high-risk or inoperable patients. However, the safety and efficacy of TAVI in MFS patients with critical aortopathy and dilated aortic annuli remain controversial due to concerns regarding annular stability, device anchoring, and long-term durability. This article reviews the existing literature, procedural challenges, and hemodynamic considerations associated with TAVI in this unique patient population, while discussing the potential risks of aortic dissection, paravalvular leak, and valve migration. Further research is warranted to establish standardized selection criteria and optimal device strategies for TAVI in MFS-related aortopathy.