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Review
. 2024 Nov 11;17(21):2455-2471.
doi: 10.1016/j.jcin.2024.08.032.

Decision-Making Approach to the Treatment of Young and Low-Risk Patients With Aortic Stenosis

Tanush Gupta  1 , S Chris Malaisrie  2 , Wayne Batchelor  3 , Konstantinos Dean Boudoulas  4 , Laura Davidson  5 , Uzoma N Ibebuogu  6 , Jacques Kpodonu  7 , Ramesh Singh  3 , Ibrahim Sultan  8 , Misty Theriot  9 , Michael J Reardon  10 , Martin B Leon  11 , Kendra J Grubb  12 ; A Perspective From the American College of Cardiology Cardiac Surgery Team and Interventional Cardiology Councils
Affiliations
Review

Decision-Making Approach to the Treatment of Young and Low-Risk Patients With Aortic Stenosis

Tanush Gupta et al. JACC Cardiovasc Interv. .

Abstract

Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice. The American College of Cardiology's Cardiac Surgery Team Section Leadership and Interventional Cardiology Councils, a multidisciplinary collaboration of cardiologists and cardiac surgeons, sought to summarize the relevant data into a decision-making tool for heart valve teams. A literature review was completed, and guidelines, randomized controlled trials, and large observational studies were summarized into a pragmatic decision-making approach to treating young and low-risk patients with AS.

Keywords: aortic stenosis; clinical practice guidelines; heart valve team; shared decision-making; surgical aortic valve replacement; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Gupta has received consulting fees from Medtronic; Dr Malaisrie has received honoraria from Edwards Lifesciences, Artivion, and Atricure; and has received research grants from Edwards Lifesciences, Medtronic, Artivion, and Terumo. Dr Batchelor has received consultant and Speakers Bureau fees and research grant support from Abbott; has received consultant fees and research grant support from Boston Scientific; and is a consultant for V-Wave and Medtronic. Dr Davidson has received research support from Edwards Lifesciences. Dr Kpodonu has received National Institutes of Health (National Institute of Biomedical Imaging and Bioengineering) funding (R33 grant). Dr Sultan has received institutional research funding from Abbott, Artivion, Atricure, Boston Scientific, Edwards Lifesciences, Medtronic, and Terumo Aortic. Dr Theroit serves on the Speakers Bureau for Edwards Lifesciences. Dr Reardon has received research support from Abbott, Boston Scientific, Jena Valve, Medtronic, and St. Jude Medical; and has received honoraria from Abbott, Boston Scientific, and Medtronic. Dr Leon has received personal and institutional grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Grubb has received consulting fees from Medtronic, Abbott, Boston Scientific, Ancora Heart, 4C Medical, Edwards Lifesciences, and OpSens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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