Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients. (15th November 2022)

• Record Type: Journal Article
• Authors: Russo, Giulio; Tang, Gilbert H.L.; Sangiorgi, Giuseppe; Pedicino, Daniela; Enriquez-Sarano, Maurice; Maisano, Francesco; Taramasso, Maurizio
• Is Part Of: Circulation. Volume 15:Number 11(2022)
• Page Start: 915
• Page End: 927
• Publication Date: 2022-11-15
• Subjects: aortic valve stenosis -- transcatheter aortic valve implantation -- transcatheter aortic valve replacement; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.122.012388
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Transcatheter aortic valve replacement is now indicated across all risk categories of patients with symptomatic severe aortic stenosis and has been proposed as first line option for the majority of patients >74 years old. However, median age of patients enrolled in the transcatheter aortic valve replacement low-risk trials is 74 years and transcatheter aortic valve replacement has never been systematically investigated in young low risk patients. Although the long-term data in surgical aortic valve replacement in young patients (age <75) are well known, such data remain lacking in transcatheter aortic valve replacement. In the absence of clear guideline recommendations in patients with challenging anatomies (eg, hostile calcium, bicuspid), it is important to know the potential advantages and disadvantages of each treatment and to consider how they might integrate with each other in the lifetime management of such patients. In this review, we discuss current outstanding issues on the management of severe aortic stenosis from a lifetime management perspective, particularly in terms of initial intervention and future reinterventions.