State-of-the-Art Review
Focus on Transcatheter Aortic Valve Replacement
Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-Risk Patients With Severe Aortic Stenosis

https://doi.org/10.1016/j.jcin.2021.03.058Get rights and content
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Highlights

  • TAVR has never been systematically tested in very young patients (<65 years).

  • Unanswered questions of durability, coronary access, and risk of redo TAVR remain.

  • Balancing these questions with patients’ preferences will be a common scenario.

  • Priority should be given to lifetime management of patients with aortic stenosis.

Abstract

Transcatheter aortic valve replacement (TAVR) is approved for all patient risk profiles and is an option for all patients irrespective of age. However, patients enrolled in the low- and intermediate-risk trials were in their 70s, and those in the high-risk trials were in their 80s. TAVR has never been systematically tested in young (<65 years), low-risk patients. Unanswered questions remain, including the safety and effectiveness of TAVR in patients with bicuspid aortic valves; future coronary access; durability of transcatheter heart valves; technical considerations for surgical transcatheter heart valve explantation; management of concomitant conditions such as aortopathy, mitral valve disease, and coronary artery disease; and the safety and feasibility of future TAVR-in-TAVR. The authors predict that balancing these questions with patients’ clear preference for less invasive treatment will become common. In this paper, the authors consider each of these questions and discuss risks and benefits of theoretical treatment strategies in the lifetime management of young patients with severe aortic stenosis.

Key Words

low-risk TAVR
surgical aortic valve replacement
TAVR in young patients
transcatheter aortic valve replacement

Abbreviations and Acronyms

ACC
American College of Cardiology
BASILICA
bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction
CI
confidence interval
HR
hazard ratio
PPM
permanent pacemaker
PVL
paravalvular leak
SAVR
surgical aortic valve replacement
SCLT
subclinical leaflet thrombosis
STS
Society of Thoracic Surgeons
SVD
structural valve degeneration
TAVR
transcatheter aortic valve replacement
THV
transcatheter heart valve

Cited by (0)

Lars Søndergaard, MD, served as Guest Editor for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs. Yerasi and Rogers contributed equally to this paper.