Is TAVR too common among younger patients? New data prompt a ‘call to action’
Far too many young patients are undergoing transcatheter aortic valve replacement (TAVR) when they should be treated with surgery instead, according to a new real-world analysis published in Circulation.[1]
The study’s authors noted that current industry guidelines recommend the use of surgical aortic valve replacement (SAVR), not TAVR, for most patients under the age of 65 years old. To learn about the decisions U.S. care teams are actively making, they reviewed data from more than 100,000 patients under the age of 65 who underwent TAVR or SAVR from 2017 to 2023. TAVR data came from the American College of Cardiology/Society of Thoracic Surgeons TVT Registry, and SAVR data came from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
Overall, the group found that TAVR was being chosen for many more patients than industry guidelines would recommend. They identified more than 69,000 SAVR patients, and more than 33,000 TAVR patients who underwent treatment from 2017 to 2023.
TAVR became more common over time, with the number of cases each year jumping from more than 2,500 in 2017 to nearly 6,000 in 2023. By that time, 36% of patients under 65 years old undergoing aortic valve replacement were being selected for TAVR over SAVR.
The frequency of SAVR in this population, meanwhile, either stayed at a comparable level or decreased.
“Ideally, well-functioning heart teams would only offer young patients TAVR if they were of prohibitive surgical risk accompanied by high comorbidity burden, or had a reduced life expectancy,” wrote first author J. Hunter Mehaffey, MD, MSc, a cardiothoracic surgeon with WVU Medicine, and colleagues. “Despite increased availability and acceptance of TAVR because of the ease of implantation and quicker recovery, it seems exceedingly unlikely that 36% of young patients would fall into this category. More concerning is the reported 9.9% one-year mortality in this young population. In conclusion, these data are an urgent call to action for evidence development in young TAVR and a renewed focus on heart team decision-making regarding appropriate TAVR use.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.