Is this a bridge too far?

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Aortic stenosis (AS) is a significant valvular heart disease.
• Transcatheter aortic valve replacement (TAVR) is an established treatment for AS, particularly in high-risk patients.
• Open surgical aortic valve replacement (SAVR) remains a standard treatment, but carries higher risks in certain populations.

Purpose of the Study:

• To report a case of TAVR followed by staged SAVR in a high-risk patient.
• To explore the potential of TAVR as a bridge to SAVR for selected younger patients with severe AS and high surgical risk.

Main Methods:

• A staged procedure involving initial TAVR followed by subsequent SAVR was performed.
• Patient selection criteria focused on high surgical risk and younger age.

Main Results:

• The case demonstrates the feasibility of a staged TAVR-then-SAVR approach.
• Optimal timing for SAVR after TAVR needs further investigation to balance surgical risk reduction and procedural complexity.

Conclusions:

• TAVR may serve as a bridge to SAVR in select younger, high-risk patients with AS.
• Long-term TAVR durability data are crucial for determining the best strategy: "destination" TAVR or bridging to SAVR.