Transcatheter Aortic Valve Implantation in Young Patients: Challenges and Perspectives—A Narrative Review

TL;DR

This review discusses the use of TAVI in young patients with aortic stenosis, highlighting challenges like complications and prosthesis durability.

Contribution

The paper provides a focused analysis of TAVI outcomes in young patients with bicuspid or rheumatic aortic stenosis.

Findings

TAVI is increasingly used in young patients due to faster recovery and fewer surgical complications.

Complications like conduction disturbances and paravalvular leaks remain a concern in young patients.

Prosthesis durability is a major challenge as young patients have longer life expectancy.

Abstract

Although most commonly diagnosed in the elderly population, aortic stenosis can affect younger patients, being the most frequent valvular disease requiring replacement interventions, either through surgical procedures (SAVR = surgical aortic valve replacement) or through transcatheter aortic valve implantation (TAVI). In young patients, aortic stenosis generally occurs due to congenital malformations, such as bicuspid aortic valves (BAVs), or to rheumatic valve disease, both of which present specific anatomical characteristics. There is an upward trend among young patients regarding TAVI, due to the possibility of avoiding the complications of open-heart surgery while offering a faster recovery, although it is important to note that complications, such as conduction disturbances, paravalvular leaks (PVL), or strokes, can arise. Because of the current lack of long-term data, the implications of these complications among young patients are not well established. Moreover, an important issue among young patients is the durability of the prosthesis, as patient survival is expected to exceed the device’s lifespan. The purpose of this review is to assess the current data on the most common causes of aortic stenosis and outcomes of TAVI in young patients, focusing on subgroups of patients with bicuspid aortic stenosis or rheumatic aortic stenosis, while emphasizing the potential complications, the durability of the aortic prosthesis, and reintervention possibilities.

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