The 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease. Should the World Jump In?

Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-risk Patients with Severe Aortic Stenosis

Aortic stenosis is a common form of acquired degenerative valvular disease associated with poor survival after the onset of symptoms. Treatment options for patients with aortic stenosis in addition to medical therapy include surgical aortic valve replacement (SAVR) with either tissue or mechanical valves, or transcatheter aortic valve replacement (TAVR) with either balloon-expandable or self-expanding valves via either transfemoral or alternative access routes. In this review, the authors discuss the current evidence and special considerations regarding the use of TAVR versus SAVR in the management of severe aortic stenosis in young (<65 years of age), low-risk patients, highlighting the history of aortic stenosis treatment, the current guidelines and recommendations, and important issues that remain to be addressed. Ultimately, until ongoing clinical trials with long-term follow-up data shed light on whether interventions for aortic stenosis can be broadened to a low-risk population, TAVR in young, low-risk patients should be undertaken with caution and with guidance from a multidisciplinary heart team.

The trade-offs in the making of the interventional heart surgeon

The current generation of heart surgeons is experiencing growing consternation with the introduction of the so-called disruptive transcatheter procedures, seemingly threatening the stability and even existence of contemporary cardiovascular surgery. We provide a commentary reporting the comparative outcomes of transcatheter therapies and conventional surgery throughout different scenarios and the evolving superiority of the surgical techniques. The upfront conclusion is that surgeons should strive to keep their surgical skills; the downfall of surgery is not anticipated and as revealed, will hold its ground for the foreseeable future.