Transcatheter aortic valve implantation or replacement? Valve durability in the context of patient life expectancy

European Heart Journal, ehab393,
Published: 01 July 2021

This editorial refers to ‘Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter versus surgical aortic valve replacement’, by T.H. Jorgensen et al. doi: 10.1093/eurheartj/ehab375.

Transcatheter aortic valve implantation (TAVI) via the transfemoral approach is now recommended as an alternative to surgical aortic valve replacement (SAVR) in older adults with severe symptomatic aortic stenosis (AS) based on the evidence provided by several prospective randomized trials. Initially, these trials included only patients with a prohibitive or high estimated surgical risk, with more recent studies confirming the benefits of TAVI even in patients with a lower surgical risk.1–3 Even so, SAVR remains appropriate in many patients for several reasons, for example patients with valve or vascular anatomy not suitable for TAVI, associated valve or coronary disease requiring surgical intervention, the need for an annular enlargement procedure, or associated aortopathy requiring ascending aortic or aortic root replacement. More importantly, we have only limited data on long-term durability of TAVI valves because the mean age of patients enrolled in the prohibitive, high and medium risk trials was 81–84 years; obviously echocardiographic data are available only in the subset of patients still alive at long-term follow-up. These studies included very few patients under the age of 65 years. Robust data on valve durability even in a somewhat younger (mean age 73 years) lower risk population extend to only 2 years in previous published studies.4 Although valve durability appears to be adequate for patients in older age groups, whether the data from these studies can be extended to younger adults with a longer life expectancy remains unclear.