Transcatheter aortic valve replacement (TAVR) has already received the green light for high-, intermediate- and low-risk profiles and is an alternative for all patients regardless of age. It is clear that there has been a push towards the use of TAVR in younger and younger patients (<65 years), which has never been formally tested in randomized controlled trials but seems inevitable as TAVR technology makes steady progress. Lifetime management as a concept will set the tone in the field of the structural heart. Some subjects in this scenario arise, including the importance of optimized prosthetic hemodynamics for lifetime care; surgical procedures in the aortic root; management of structural valve degeneration with valve-in-valve procedures (TAVR-in-surgical aortic valve replacement [SAVR] and TAVR-in-TAVR) and redo SAVR; commissural alignment and cusp overlap for TAVR; the rise in the number of surgical procedures for TAVR explantation; and the renewed interest in the Ross procedure. This article reviews all these issues which will become commonplace during heart team meetings and preoperative conversations with patients in the coming years.

中文翻译：

---

主动脉瓣疾病的终生管理：调整手术和经导管设备，为现在和未来定下基调

经导管主动脉瓣置换术 (TAVR) 已经获得了高、中和低风险特征的绿灯，并且是所有患者的替代方案，无论年龄大小。很明显，在越来越年轻的患者（<65 岁）中使用 TAVR 的趋势很明显，这从未在随机对照试验中进行过正式测试，但随着 TAVR 技术的稳步发展，这似乎是不可避免的。终身管理作为一个概念将在结构心脏领域定下基调。在这种情况下会出现一些主题，包括优化假肢血流动力学对终生护理的重要性；主动脉根部的外科手术；通过瓣中瓣手术（TAVR-in-surgical 主动脉瓣置换术 [SAVR] 和 TAVR-in-TAVR）和重做 SAVR 来管理结构性瓣膜退变；TAVR 的连合对齐和尖端重叠；TAVR 外植外科手术数量的增加；以及对罗斯程序的新兴趣。本文回顾了所有这些将在未来几年心脏团队会议和术前与患者交谈中变得司空见惯的问题。