Transcatheter vs surgical aortic valve implantation: age vs lifetime perspective

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25 June 2026 (Last updated: 25 Jun 2026 15:37)

An article endorsed by the SCTS and other international cardiac surgical societies, recently published in the European Heart Journal.

The paper provides an important perspective on the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease and the evolving role of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR).

TAVI has transformed the treatment of aortic stenosis and delivered substantial benefits for many patients, particularly those who are older, frailer or at increased procedural risk. It represents one of the most important advances in cardiovascular medicine in recent decades.

While contemporary trials have demonstrated excellent outcomes for TAVI in selected low-risk patients, follow-up remains limited especially for patients around 70 years of age. For fit patients with a life expectancy exceeding 10 years, there remains a strong evidence-based argument that SAVR should be regarded as the benchmark therapy. SAVR offers proven durability, preserves coronary access, maintains future treatment options, and provides a robust platform for subsequent interventions should they become necessary.

Recent longer-term follow-up data, including form the Evolut Low Risk Trial, in which TAVI was shown to lead to increased rates of reoperation for severe aortic regurgitation at 6 to 7 years, has reinforced the need for careful consideration of valve durability, coronary access, future reintervention strategies and lifetime treatment planning in young patients.

Assessment of treatment pathways should include the cumulative impact of repeat procedures, including their associated morbidity, mortality, healthcare utilisation, and cost. A strategy that appears attractive in the short term may prove less advantageous if it results in more complex reinterventions, fewer future treatment options, or greater lifetime healthcare burden. These considerations are increasingly important as we treat younger patients with longer anticipated survival.

The key message is not that TAVI and SAVR are competing therapies, but that they are complementary treatments which should be selected according to patient characteristics, anatomy, comorbidity, life expectancy, and patient preference within a multidisciplinary Heart Team.

SCTS remains committed to supporting evidence-based, patient-centred decision-making and ensuring that patients continue to have access to the full range of treatment options. We will continue to work closely with our cardiology colleagues, international partners, and guideline committees to ensure that future recommendations reflect both emerging evidence and the long-term interests of our patients.

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