Decision-Making Approach to The Treatment of Young and Low-Risk Patients with Aortic Stenosis (JACC Cardiovascular Interventions November 2024)-Article: Decision-Making Approach to The Treatment of Young and Low-Risk Patients with Aortic Stenosis

Article: Decision-Making Approach to The Treatment of Young and Low-Risk Patients with Aortic Stenosis

Pdf Summary

The review discusses strategies for selecting optimal treatments for young, low-risk patients with severe aortic stenosis (AS). Over a decade of research indicates transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) as viable options. American guidelines recommend both for low-risk patients aged 65-80, although TAVR growth, particularly for those around 65, lacks comprehensive data support. This review, led by the American College of Cardiology, delivers a decision-making framework for heart valve teams. <br /><br />Key points include:<br />- **Guideline-based Recommendations**: The 2020 guidelines suggest individualizing treatment based on age, anticoagulation needs, and valve durability predictions. Historically, SAVR was advised for younger patients with longer life expectancies, while TAVR has recently gained traction.<br />- **Anatomic and Procedural Considerations**: Detailed anatomical assessments using multidetector computed tomography (MDCT) help determine candidacy for TAVR vs. SAVR. Factors include coronary height, aortic annulus size, and patients’ overall physical condition. High-risk anatomies for both TAVR and SAVR are identified to guide decision-making.<br />- **Durability and Future Interventions**: Valve durability in younger patients is crucial as their life expectancy often exceeds that of the valve. The potential for re-interventions such as redo-TAVR emphasizes TAVR's growing prominence but also its challenges.<br />- **Patient Preferences and Socioeconomic Context**: Personal and socioeconomic factors heavily influence treatment path decisions. Many patients prefer TAVR for quicker recovery despite potential long-term intervention needs.<br />- **Ongoing Research and Future Insights**: Long-term studies are eagerly awaited to provide insights into the life span and durability of bioprosthetic valves post-TAVR or SAVR, helping refine guidelines.<br /><br />The review emphasizes shared decision-making between patients and heart valve teams, considering clinical evidence, patient anatomy, and lifestyle preferences, supplemented by expert consensus and computational modeling for the best outcomes.

Keywords

aortic stenosis

TAVR

SAVR

heart valve replacement

clinical guidelines

patient decision-making

valve durability

multidetector computed tomography

bioprosthetic valves

American College of Cardiology