Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

Abstract

During the last decade, transcatheter aortic valve implantation (TAVI) has represented a valid alternative to surgical aortic valve replacement in patients with aortic stenosis and elevated surgical risk. Recent randomized clinical trials reported excellent results also for patients at low surgical risk, but in clinical practice, the mean age of the patients treated remain over 75 years, and the presence of a bicuspid aortic valve still represents an important exclusion criteria. Today, aortic valve replacement with a mechanical prosthesis remains the treatment of choice for young adults with aortic stenosis, although the desire to avoid oral anticoagulants drives more patients younger than 65 years of age towards biological prostheses. Furthermore, despite the follow-up of patients after TAVI is still limited to a few years, the opportunity of a second percutaneous treatment (TAVI-in-TAVI), extends the scope of percutaneous strategy. In the next few years, TAVI has to face many challenges to become a valid alternative to surgery in the younger patients as well.

Inflammatory immune response in recipients of transcatheter aortic valves

“…We believe that the medical community should be cautioned against the uncritical lowering of age limits in recipients of a-Gal-bearing TAVI devices. 46 Values are reported as median (interquartile range). Ig, Immunoglobulin; sST2, soluble suppression of tumorigenicity-2; c3a, complement factor 3a; citH3, citrullinated H3.…”

“…We believe that the medical community should be cautioned against the uncritical lowering of age limits in recipients of α-Gal–bearing TAVI devices. 46 …”

An Unusual Case of Severe Aortic Stenosis and Triple-Vessel Coronary Artery Disease in a Patient Presenting With Intermittent Chest Pain

“…Aortic stenosis in young adults (aged 20-65 years) remains rare, with an estimated incidence between 10 and 75 individuals/100,000 per year [ 6 ]. Similarly, the prevalence of CAD in patients undergoing SAVR increases with age [ 7 ].…”

A Sneak-Peek into the Physician’s Brain: A Retrospective Machine Learning-Driven Investigation of Decision-Making in TAVR versus SAVR for Young High-Risk Patients with Severe Symptomatic Aortic Stenosis

“…As illustrated by the 2020 valvular heart disease guidelines, the focus of research is shifting to accommodate age-related considerations [9]. Before TAVR can be deemed safe to use in all age groups, concerns including prosthesis durability, the long-term consequences of TAVRinduced conduction abnormalities, the challenges posed by bicuspid valves, the access to the ostia of the coronary arteries and the long-term outcomes of valve-in-valve procedures need to be addressed [10,24,[26][27][28]. Thus, despite the increasing availability of data on TAVR in lower risk patient groups, the young high-risk patients included in our study still constitute a relatively underrepresented collective, making the major determinants of the decision-making process as relevant now as they were then.…”