Health system analysis reveals shift toward less invasive heart valve replacement among younger patients

A recent study analyzing procedures at the Baylor Scott & White Health system found that the number of transcatheter aortic valve replacement (TAVR) surgeries among patients under 70 increased ninefold from 15 in 2014 to 134 in 2024. While surgical aortic valve replacement (SAVR) remained the more common approach across all age groups, the rise in TAVR was primarily driven by patients aged 60 to 69, whose annual volume grew from 14 to 121 procedures during the same period.

TAVR, a minimally invasive procedure that uses a catheter to deliver a replacement valve without opening the chest, typically results in a shorter recovery time compared to SAVR, which involves open-heart surgery. However, the choice between TAVR and SAVR is particularly complex for younger patients, as the initial procedure may impact future treatment options.

Factors such as bioprosthetic valve durability, structural valve deterioration, and the potential need for subsequent interventions are crucial considerations, especially for those with substantial anticipated longevity.

The study also observed lower unadjusted rates of acute kidney injury after TAVR compared to SAVR among patients aged 50 to 59 and 60 to 69. Additionally, acute kidney injury and bleeding after TAVR declined over time, while the rates of stroke and 30-day mortality remained stable. However, the authors emphasized that the comparisons between TAVR and SAVR were unadjusted and descriptive, meaning they cannot definitively establish the superiority or equivalence of either treatment.

Furthermore, the study's results may not be generalizable beyond the single health system where the analysis was conducted, and it did not assess long-term valve durability, reintervention, late stroke, or overall survival. The authors acknowledged that further long-term follow-up would be necessary to inform lifetime treatment strategies for younger patients.