Is It Too Soon to Consider TAVR for Younger, Low-Risk Patients?

A Sunday session will explore whether transcatheter aortic valve replacement (TAVR) is an appropriate treatment option for all low-risk patients, especially younger ones. One factor clouding the issue: long-term durability remains an open question.

“TAVR has become an established form of therapy for the treatment of aortic valve disease in a very short time,” said Edward P. Chen, MD, from Emory University in Atlanta. “Where it will ultimately fall in the spectrum of treatment options for structural heart disease is still unclear. The low-risk population approval suddenly expands the treatment options we have for these patients, but the long-term outcome data are yet to be determined.”

Dr. Chen will co-moderate the TAVR session with Ourania Preventza, MD, MBA, from Baylor College of Medicine in Houston.

Edward P. Chen, MD

Edward P. Chen, MD

The US Food and Drug Administration’s 2019 approval of TAVR for patients at low surgical risk could transform the treatment of aortic valve disease, but only if research supports long-term durability.

Evolving Impact: TAVR in Low-Risk Patients—Results of the Evolut Low Risk and PARTNER 3 Trials

12:45 p.m. – 2:45 p.m.
Room 208

“Expanding TAVR to low-risk populations will potentially change the way we replace aortic valves for approximately 70% of patients, perhaps more,” said Dr. Preventza.

While the mean age of patients in the low-risk trials was approximately 70 years, cardiac surgeons see a growing number of younger patients in their 50s and 60s—and a 50-year-old TAVR recipient who is otherwise in good health can expect to live another 20 to 30 years. Since only 1-year outcomes data currently are available for this low-risk population, it is impossible to know how well the valves will perform after 10 to 20 years or if they’ll even last. “For lower-risk patients, we would like to see longer-term data,” Dr. Preventza noted.

Ourania Preventza, MD, MBA

Ourania Preventza, MD, MBA

Another important issue expected to be discussed in the session is the original approval of TAVR in higher-risk populations. With evidence that some results from the early PARTNER trials were not included in the original publication, the overall message of TAVR versus surgery could potentially change, according to Dr. Chen.  

“We should consider what is best for each patient individually in order to optimally determine the ultimate role of TAVR in the overall treatment paradigm of aortic valve disease,” he said. “This session is our opportunity to explore all of those issues together.”