That said, it’s “very important that we don’t jump on the bandwagon of TAVR is the treatment for everyone, regardless of age,” he added. For instance, TAVI could be the right choice in a young patient who has undergone radiation therapy for cancer but isn’t a surgical candidate. It’s ‘very important that we don’t jump on the bandwagon of TAVR is the treatment for everyone, regardless of age.’ Toby Rogersįlexibility allows for tailored treatment in specific scenarios, said Rogers. The state-of-the-art review, published online yesterday in JACC: Cardiovascular Interventions, discusses factors that influence decision-making below the age of 65 years-the need for anticoagulation but durability with mechanical valves, for instance, versus the freedom from long-term anticoagulation but need for reintervention with bioprosthetic valves, as well as the risks and benefits seen with various sequences of surgical and transcatheter redo procedures. We thought it was important to summarize all the evidence, just to be very mindful that we still don’t have good data in younger patients-and that just because it’s approved doesn’t mean it’s the right treatment for everyone.”Ĭurrent US guidelines for valvular heart disease say that most patients younger than 50 are best served by a surgically implanted mechanical valve, while “uncertainty and debate continue about which type of AVR is appropriate for patients 50 to 65 years of age.” US Food and Drug Administration approval for TAVI does not specify an age cutoff. “TAVR is now approved theoretically across the board for low-, intermediate-, high-, and extreme-risk patients,” Rogers said, “and that raises the potential for every patient with aortic stenosis either being offered or coming and requesting TAVR. Toby Rogers, MD, PhD (MedStar Washington Hospital Center, Washington, DC, and National Institutes of Health, Bethesda, MD), who led the paper along with Charan Yerasi, MD (MedStar Washington Hospital Center), stressed a similar point to TCTMD. However, these results should be extrapolated to younger patients with caution.”

“The pivotal TAVR trials in low-risk patients have, so far, demonstrated excellent clinical outcomes. Low risk and younger age are categories that should not be conflated, they urge. As the authors of a new review point out, though, much is still unknown about how youth can impact outcomes and future options. Transcatheter aortic valve implantation is approved in the United States for low-risk patients with severe aortic stenosis, without an age threshold.

Be mindful