Despite a TAVR popularity surge in recent years, a Vizient registry analysis suggests the procedure’s prevalence has stabilized in patients under 65, but there’s still significant debate on whether the young patient TAVR rate is appropriate.
- U.S. and EU guidelines currently recommend SAVR over TAVR for patients younger than 65 given the lack of long-term durability data and decades of remaining life expectancy.
- TAVR in younger patients has been the center of intense debate over the last few years, with some observational studies suggesting TAVR now makes up 50% of AVRs under 65.
Getting to the bottom of the TAVR question, researchers examined aortic valve replacement procedures in under-65 patients from 2016-2024 and found an unexpected plateau…
- TAVR volumes grew exponentially through 2020 reaching 36.8% of all procedures while isolated SAVR declined to 27.4%.
- However, between 2020-2024 the TAVR rate reversed and stabilized around 29%.
- Intriguingly, the Ross procedure grew steadily from 0.4% in 2016 to 4.8% in 2024.
While that TAVR rate of 29% comes in well below the 50% that observational studies predicted, it still seems high considering that SAVR is a class I recommendation for patients under 65.
- This trend is especially concerning given that recent studies on valve-in-valve repair also show worse outcomes than redo SAVR.
One encouraging trend from the study is that concomitant SAVR rates (ascending aorta, CABG, MVR, etc.) remained stable throughout the study period.
- Concomitant SAVR rates peaked in 2017 at 40.4% and nudged down to 34.3% in 2021.
The Takeaway
A brilliant cardiologist once warned that TAVR-ing the masses could have consequences, and while the minimally invasive procedure has its benefits, this study does remind us that it can be over-used in the wrong patient group.
