Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review.

Pier Paolo Bocchino,Giovanni Pedrazzini,Gaetano Maria De Ferrari,Gregorio Tersalvi,Gaetano Senatore,Giacomo Maria Cioffi,Filippo Angelini,Federico Conrotto,Luigi Biasco,Brunilda Alushi

doi:10.3389/fcvm.2020.608158

Abstract

In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. The efficacy and safety of TAVR were first proven in inoperable and high-risk patients. Then, subsequent randomized clinical trials showed non-inferiority of TAVR as compared to surgical aortic valve replacement also in intermediate- and low-risk populations. As TAVR was progressively studied and clinically used in lower-risk patients, issues were raised questioning its opportunity in a younger population with a longer life-expectancy. As long-term follow-up data mainly derive from old studies with early generation devices on high or intermediate surgical risk patients, results can hardly be extended to most of currently treated patients who often show a low surgical risk and are treated with newer generation prostheses. Thus, in this low-risk younger population, decision making is difficult due to the lack of supporting data. The aim of the present review is to revise current literature regarding TAVR in younger patients.

Highlights

Aortic stenosis (AS) is the most common valvular heart disease in the adult population and its prevalence progressively increases according to population aging [1]
transcatheter aortic valve replacement (TAVR) significantly reduces the rate of all-cause death (HR 0.55), CV death (HR 0.39), death + rehospitalization (HR 0.46), symptoms and 6MWD at 1 yr and non-significantly increases major stroke rate at 30 days (5.0 vs. 1.1%, p 0.06) and 1 yr (7.8 vs. 3.9%, p 0.18)
Shorter hospital stay and shorter ICU stay in TAVR patients

Summary

Introduction

Aortic stenosis (AS) is the most common valvular heart disease in the adult population and its prevalence progressively increases according to population aging [1]. Medical therapy yields poor outcomes in severe symptomatic AS treatment and surgical aortic valve replacement (SAVR) has long been considered the standard of care in suitable symptomatic patients with severe AS [2]. The development of transcatheter aortic valve replacement (TAVR) provided a new strategy for their treatment that rapidly became a valid alternative approach in a progressively larger proportion of patients. The procedure of TAVR has significantly evolved over the years. From the very first pioneering implant by Cribier, performed through a trans-venous, trans-septal, retrograde approach [3], nowadays procedural steps have been clearly defined.

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Conclusion