Clinical Conundrum: Lifetime Management of Aortic Stenosis in Young Patients

The management of aortic stenosis (AS) in younger patients presents significant clinical challenges. While transcatheter aortic valve replacement (TAVR) offers a minimally invasive approach with favourable short- and mid-term outcomes, its long-term efficacy in patients under 65 years remains uncertain, particularly given the extended life expectancy of these patients. Current guidelines favour surgical aortic valve replacement for younger individuals due to concerns about the durability of TAVR valves. However, an increasing number of younger patients are opting for TAVR, drawn by its shorter hospital stay and reduced operative complications, revealing a disconnect between clinical practice and established guidelines. This discrepancy underscores the need for alternative strategies. Emerging technologies such as novel implant-free devices, show promise in extending valve life and delaying the need for TAVR. Additionally, ongoing research into pharmaceutical interventions, including RNA-based therapies and anti-calcification drugs, aims to slow the progression of AS. As the field evolves, there is a growing emphasis on developing strategies that balance immediate patient benefits with long-term outcomes, ultimately enhancing the quality of life and survival rates for younger individuals with AS. This review highlights the necessity of innovative approaches tailored to the unique needs of this population, emphasising the importance of continued research and adaptation of clinical practices.