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Published on: March 26, 2018
Expanding Transcatheter Aortic Valve Replacement Use in Younger Patients and Bicuspid Valves: Risks, Evidence Gaps,
1Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University Medical School, Stanford, California.
Transcatheter aortic valve replacement (TAVR) shows concerning midterm risks like stroke and mortality in younger bicuspid aortic valve patients. Long-term TAVR effectiveness remains unproven, necessitating further research before wider use.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Bioprosthetic Heart Valves
Background:
- Transcatheter aortic valve replacement (TAVR) use is increasing in younger patients with bicuspid aortic valves (BAV).
- Concerns exist regarding the long-term efficacy and durability of TAVR in patients under 70.
- The
- valve-in-valve
- approach is growing for degenerated surgical valves and TAVR failure.
Purpose of the Study:
- To review midterm outcomes of TAVR in younger BAV patients.
- To assess the unproven long-term effectiveness of TAVR in this demographic.
- To evaluate the trend of valve-in-valve procedures.
Main Methods:
- Expert review of recent observational studies.
- Analysis of registry data.
- Examination of limited randomized evidence.
Main Results:
- Midterm TAVR in younger BAV patients shows elevated mortality, stroke, and pacemaker dependency compared to surgical aortic valve replacement.
- Long-term outcomes and durability of TAVR in patients <70 years are largely untested.
- Valve-in-valve TAVR is increasingly used for bioprosthetic degeneration and TAVR failure.
Conclusions:
- Rigorous, long-term randomized controlled trials are needed before broader TAVR adoption in younger BAV patients.
- Current policy should align with evidence, challenging market-driven expansion of TAVR.
- Further investigation is crucial for guideline-directed care in TAVR and valve-in-valve TAVR.
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