Three in 10 AVRs in Adults Younger Than 65 Are Transcatheter

Why It Matters

The shift toward TAVI in younger patients could alter long‑term durability, re‑intervention rates, and overall health‑system costs, making guideline adherence and heart‑team decision‑making critical.

Key Takeaways

• 28.5% of patients <65 received TAVI, up from 15.7% in 2016.
• Isolated SAVR dropped from 43.8% to 27.0% over same period.
• TAVI growth stalled after 2020, suggesting possible heart‑team impact.
• Experts debate whether 30% TAVI use breaches age‑based guidelines.
• Ongoing bicuspid trials aim to clarify TAVI suitability for younger patients.

Pulse Analysis

The past decade has seen transcatheter aortic valve implantation (TAVI) move from a niche option for high‑risk, elderly patients to a mainstream alternative for a broader spectrum of aortic stenosis. In the Vizient Clinical Database, 34,504 U.S. adults younger than 65 who underwent aortic valve replacement between 2016 and 2024 were analyzed. TAVI accounted for 28.5% of procedures, climbing from 15.7% in 2016 to a peak of 36.8% in 2020 before stabilizing around 29% in 2024. During the same interval, isolated surgical aortic valve replacement (SAVR) fell from 43.8% to 27.0%, reflecting a clear shift in treatment patterns.

Guidelines from both the American College of Cardiology/American Heart Association and the European Society of Cardiology still recommend SAVR as the first‑line therapy for patients under 65, citing limited long‑term durability data for TAVI in this age group. Yet nearly one‑third of the cohort received a transcatheter device, prompting concerns about “age creep” and “risk creep.” The heart‑team model—pairing cardiac surgeons with interventional cardiologists—has been championed as a safeguard, but recent commentary highlights pockets where surgeon input may be bypassed, especially as CMS reviews the national coverage determination for TAVI.

Looking ahead, the next iteration of valvular disease guidelines will likely address these tensions, emphasizing anatomical and comorbidity factors alongside age. Ongoing randomized trials such as NAVIGATE Bicuspid and BELIEVERS are poised to provide the missing evidence on TAVI performance in bicuspid and younger anatomies. Until robust long‑term outcomes are available, clinicians must balance the procedural convenience of TAVI against potential re‑intervention costs and valve durability, ensuring that patient selection remains rooted in multidisciplinary judgment rather than a simple age cutoff.