Aortic Stenosis in the Low-Risk Patient: Overview of the Management Options and Possible Permutations.

Abstract

Young and low-risk patients with aortic stenosis pose a clinical dilemma. The need for life-long anticoagulation with mechanical prostheses, the risk of early degeneration of stented and stentless bioprostheses, the unknown long-term outcomes of transcatheter valve implantation and the high surgical risk of a Ross procedure all have long-term implications namely with regards to re-operation strategy. Aortic valve intervention can take several forms: surgical valve replacement with a stented or stentless bioprosthesis or with a mechanical prosthesis, transcatheter aortic valve implantation (TAVI), and the Ross procedure.1 While the choice of strategy is often straightforward in the elderly and high-risk population, young and low-risk patients with aortic stenosis are challenging to the Heart Team, namely because of their longer life expectancy, and higher cumulative life-time risk of valve-related complications.1 Herein, we review the currently available options for first and subsequent interventions for managing aortic stenosis in low-risk patients.