Lifetime management for aortic stenosis: Planning for future therapies

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• The increasing approval of low-risk transcatheter aortic valve replacement (TAVR) necessitates a focus on lifetime management strategies for aortic valve disease.
• Younger patients undergoing aortic valve replacement face unique challenges regarding long-term durability and re-intervention options.

Purpose of the Study:

• To review and compare different lifetime management approaches for aortic valve replacement in younger patients.
• To evaluate procedural safety, durability, performance, and future re-intervention options for surgical aortic valve replacement (SAVR) and TAVR strategies.
• To analyze how initial therapy choices impact subsequent treatment possibilities.

Main Methods:

• Literature review of studies on TAVR and SAVR in younger patient populations.
• Comparative analysis of re-intervention strategies following bioprosthetic valve failure after SAVR (TAV-in-SAV, redo SAVR).
• Evaluation of re-intervention options after TAVR failure (TAVR explant with SAVR, TAV-in-TAV) and implications for third interventions.

Main Results:

• Initial SAVR in younger patients may lead to TAV-in-SAV or redo SAVR for bioprosthetic failure.
• TAVR failure in younger patients can be managed with TAVR explant and SAVR, or TAV-in-TAV.
• The choice between SAVR and TAVR can significantly influence the availability and feasibility of future interventions.

Conclusions:

• Lifetime management planning is crucial for younger patients undergoing aortic valve replacement, considering the potential for multiple interventions.
• The decision between SAVR and TAVR should incorporate an assessment of long-term valve performance and the spectrum of future re-intervention options.
• Understanding the implications of initial therapy on subsequent treatment pathways is essential for optimizing patient outcomes in aortic valve disease management.