The University of Rochester observational analysis of 14,000 Vizient cases (2018-2023) reveals nearly half of low-risk adults under 65 received TAVR despite guidelines favoring SAVR. This non-randomized study, lacking RCT rigor, highlights hospital-level variation but cannot prove causation. Younger patients face bioprosthetic degeneration within 5-10 years, necessitating high-risk TAVR explant-SAVR hybrids with elevated stroke and mortality rates. PARTNER 3 (RCT, n=1000 low-risk) showed short-term equivalence yet excluded long-term durability endpoints critical for those with 20+ year life expectancy. A 2024 JACC review of explant registries documented 15% complication rates in TAVR failures versus primary SAVR. Original coverage omitted lifetime valve management strategies now central to AHA/ACC guidelines and patient-specific factors like bicuspid valves that accelerate failure. Multidisciplinary heart teams must model projected reinterventions rather than defaulting to minimally invasive appeal.