Time to Explore Transcatheter Aortic Valve Replacement in Younger, Low-Risk Patients

During the last decade transcatheter aortic valve replacement (TAVR) has been established as a treatment for patients with severe aortic stenosis, who are at particularly high surgical risk. As compared with surgical aortic valve replacement (SAVR), TAVR has been associated with lower early risk of mortality, atrial fibrillation, acute kidney injury, and bleeding. Furthermore, device and periprocedural improvements have addressed most of the initial limitations for TAVR, including the Achilles' heel, paravalvular leakage. Supported by this as well as preliminary data among lower-risk patients, TAVR is currently being evaluated in prospective randomized trials against SAVR in younger low-risk patients. Although durability of the TAVR device may be of concern in younger patients given their longer life expectancy, intermediate-term controlled data does not reveal any difference between TAVR and SAVR devices. (C) 2016 by the American College of Cardiology Foundation.