Why the study?
TAVR is increasingly used in younger patients (<65 years) without formal randomized trial testing, making lifetime management strategies and integrating surgical and transcatheter approaches essential.
As TAVR indications expand to younger and lower-risk patients, lifetime management strategies including valve sequencing, TAVR explantation, and the Ross procedure will become essential components of heart team decision-making.
TAVR expansion to patients <65 warrants caution absent RCT data; leaves open optimal lifetime management strategies.
Transcatheter aortic valve replacement (TAVR) has already received the green light for high-, intermediate- and low-risk profiles and is an alternative for all patients regardless of age. It is clear that there has been a push towards the use of TAVR in younger and younger patients (<65 years), which has never been formally tested in randomized controlled trials but seems inevitable as TAVR technology makes steady progress. Lifetime management as a concept will set the tone in the field of the structural heart. Some subjects in this scenario arise, including the importance of optimized prosthetic hemodynamics for lifetime care; surgical procedures in the aortic root; management of structural valve degeneration with valve-in-valve procedures (TAVR-in-surgical aortic valve replacement [SAVR] and TAVR-in-TAVR) and redo SAVR; commissural alignment and cusp overlap for TAVR; the rise in the number of surgical procedures for TAVR explantation; and the renewed interest in the Ross procedure. This article reviews all these issues which will become commonplace during heart team meetings and preoperative conversations with patients in the coming years.
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Sá et al. (2021) studied this question.
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