Lifetime management of valvular heart disease in younger and low risk patients.

Abstract

Valvular heart disease in younger and low-risk patients presents unique therapeutic challenges because treatment decisions must account not only for immediate procedural success but also for the durability of the index intervention, the feasibility of future reinterventions, and the preservation of subsequent treatment options. Consequently, lifetime management has emerged as a longitudinal treatment paradigm in which every intervention influences the sequence, complexity, and outcomes of future procedures. Over the past decade, transcatheter valve therapies have expanded rapidly from a treatment reserved for elderly and high-surgical-risk patients to an increasingly adopted option in younger and lower-risk populations. Although contemporary evidence has demonstrated excellent procedural safety and mid-term outcomes, important uncertainties remain regarding long-term durability and the optimal management of structural valve deterioration and repeat interventions. These considerations highlight the importance of approaching each intervention not as an isolated procedure, but as a step within a predefined lifetime therapeutic strategy. In this context, structured Heart Team discussion and shared decision-making are fundamental to develop an individualized treatment plan that optimizes outcomes while preserving future surgical and transcatheter options across decades of patient care. This review aims to provide a practical framework for the lifetime management of aortic, mitral, and tricuspid valve disease in younger and low-risk patients.