December 14, 2020Open Access

Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review

Q: What is the clinical evidence from this study?

Study design: Review. Population: Severe Aortic Stenosis. Intervention: Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR).

Key Result

Transcatheter aortic valve replacement is increasingly adopted in younger, low-risk patients with severe aortic stenosis, though long-term valve durability and conduction disturbances remain unresolved.

Structured PICO

Does transcatheter aortic valve replacement improve outcomes compared to surgical aortic valve replacement in young low-risk patients with severe aortic stenosis?

Population

A narrative review evaluating the evidence, clinical scenarios, and open issues regarding transcatheter aortic valve replacement in younger, low-risk patients with severe aortic stenosis.

Intervention

Transcatheter aortic valve replacement (TAVR)

Comparator

Surgical aortic valve replacement (SAVR) or conservative management

Outcome

Clinical outcomes including mortality, stroke, and procedural complications

While TAVR is expanding to lower-risk populations, its use in young patients (60-75 years) requires careful consideration of valve durability, bicuspid anatomy, and conduction disturbances.

Limitations

Long-term follow-up data mainly derive from older studies with early generation devices on high or intermediate surgical risk patients.
Surgical risk scores perform poorly in younger patients undergoing TAVR.

Abstract

In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. The efficacy and safety of TAVR were first proven in inoperable and high-risk patients. Then, subsequent randomized clinical trials showed non-inferiority of TAVR as compared to surgical aortic valve replacement also in intermediate- and low-risk populations. As TAVR was progressively studied and clinically used in lower-risk patients, issues were raised questioning its opportunity in a younger population with a longer life-expectancy. As long-term follow-up data mainly derive from old studies with early generation devices on high or intermediate surgical risk patients, results can hardly be extended to most of currently treated patients who often show a low surgical risk and are treated with newer generation prostheses. Thus, in this low-risk younger population, decision making is difficult due to the lack of supporting data. The aim of the present review is to revise current literature regarding TAVR in younger patients.

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Cite This Study

Bocchino et al. (Mon,) conducted a review in Severe Aortic Stenosis. Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated. Transcatheter aortic valve replacement is increasingly adopted in younger, low-risk patients with severe aortic stenosis, though long-term valve durability and conduction disturbances remain unresolved.

synapsesocial.com/papers/6a445ebc91c82169f0615dbe https://doi.org/https://doi.org/10.3389/fcvm.2020.608158

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