Bhogal S, Batta A. Transcatheter aortic valve replacement in low-risk young population: A double edge sword? World J Cardiol 2024; 16(4): 177-180 [PMID: 38690217 DOI: 10.4330/wjc.v16.i4.177]
Corresponding Author of This Article
Akash Batta, Doctor, MD, Assistant Professor, Researcher, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, India. akashbatta02@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2024; 16(4): 177-180 Published online Apr 26, 2024. doi: 10.4330/wjc.v16.i4.177
Transcatheter aortic valve replacement in low-risk young population: A double edge sword?
Sukhdeep Bhogal, Akash Batta
Sukhdeep Bhogal, Department of Cardiology, Sovah Health, Martinsville, VA 24112, United States
Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, India
Author contributions: Bhogal S and Batta A wrote the manuscript, read and approved the final manuscript; they have contributed equally to this manuscript.
Conflict-of-interest statement: The authors declare no conflict-of-interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akash Batta, Doctor, MD, Assistant Professor, Researcher, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, India. akashbatta02@gmail.com
Received: December 1, 2023 Peer-review started: December 1, 2023 First decision: February 5, 2024 Revised: February 12, 2024 Accepted: March 26, 2024 Article in press: March 26, 2024 Published online: April 26, 2024
Abstract
Since the advent of transcatheter aortic valve replacement (TAVR) in 2002, it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis, particularly in intermediate to high-surgical risk patients. In 2019, the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials. However, these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles. While currently there is no randomized study of TAVR in young patients, it may be preferred by the young population given the benefits of early discharge, shorter hospital stay, and expedite recovery. Nonetheless, it is important to ruminate various factors including lifetime expectancy, risk of pacemaker implantation, and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients. Furthermore, the data on long-term durability (> 10 years) of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population. Thus, this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.
Core Tip: In 2019, the United States Food and Drug Administration approved transcatheter aortic valve replacement (TAVR) in low-risk patients based on the two large randomized trials. However, patients with certain unfavorable anatomies and clinical profiles were excluded from these trials. Despite the lack of clear evidence in young patients (< 65 years), it may be preferred by this population given the benefits of early discharge, shorter hospital stay, and expedite recovery. Nonetheless, it is important to ruminate various factors including lifetime expectancy, risk of pacemaker implantation, and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients.
