Lifelong Management of Aortic Stenosis in Young Women: A Comprehensive Review

Despite similar burdens of aortic stenosis (AS) in men and women, management guidelines have historically focused on older, male populations. Age and sex differences contribute to variances in symptomatology and postprocedural outcomes. This review aims to evaluate strategies for lifelong management of AS in young women, specifically during childbearing age and pregnancy, and in women with failed bioprosthetic valves. Advanced surgical options such as the Ross and Ozaki Procedures, in addition to transcatheter aortic valve repair (TAVR) and traditional surgical aortic valve repair (SAVR), are viable options for young women with AS. However, valve durability and reintervention rates for each procedure remain major factors that affect decision-making. Maternal and fetal complications are of paramount concern when treating pregnant patients. Effects of altered uterine-placental blood flow and the risk of intraprocedural fetal irradiation should be considered when choosing an intervention for these patients, and efforts should be made to minimize risks to both mother and fetus. Current options for young women with failed bioprosthesis include redo-SAVR, TAVR in SAVR, TAVR in TAVR, and redo-SAVR after TAVR. These options are often associated with high rates of procedural complications and pitfalls compared to initial intervention in young women. No single treatment modality emerges as the best option for young women with AS. Ultimately, care should be tailored to each young woman by considering their clinical condition, reproductive goals, personal preferences, and associated comorbidities.