Transcatheter aortic valve replacement in low-risk young population: A double edge sword?

Abstract

Since the advent of transcatheter aortic valve replacement (TAVR) in 2002, it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis, particularly in intermediate to high-surgical risk patients. In 2019, the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials. However, these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles. While currently there is no randomized study of TAVR in young patients, it may be preferred by the young population given the benefits of early discharge, shorter hospital stay, and expedite recovery. Nonetheless, it is important to ruminate various factors including lifetime expectancy, risk of pacemaker implantation, and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients. Furthermore, the data on long-term durability (> 10 years) of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population. Thus, this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.

Keywords: Transcatheter aortic valve replacement; Surgical aortic valve replacement; Pacemaker implantation; Coronary re-access; Structural deterioration

Core Tip: In 2019, the United States Food and Drug Administration approved transcatheter aortic valve replacement (TAVR) in low-risk patients based on the two large randomized trials. However, patients with certain unfavorable anatomies and clinical profiles were excluded from these trials. Despite the lack of clear evidence in young patients (< 65 years), it may be preferred by this population given the benefits of early discharge, shorter hospital stay, and expedite recovery. Nonetheless, it is important to ruminate various factors including lifetime expectancy, risk of pacemaker implantation, and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients.