Oct 5, 2026 · 39 min · 11 segments
As #TAVI moves into younger and lower-risk populations, one question is becoming increasingly common in Heart Team discussions: what should we do with a 71-year-old patient with severe aortic…
Dejan MilasinovicHostYeah, well, then the first question, you know, when we look at the title of this conversation, you know, the question is for you today in your center, is TAVI the right choice for a 70-year-old patient?
Let me just, to begin with, just quickly deep dive in the new guidelines that we have received last year at ESC Congress.
And I think there were many interesting novelties with new recommendations, you know, for asymptomatic patients, for patients with bicuspid aortic valve stenosis.
But above all, I think the new age cutoff was proposed to determine treatment strategies that really changed our And I think if the anatomy is suitable, then at least in my center, German Heart Center Munich, TAVI is now standard of care in all the patients over 70 years of age, given that the anatomy is suitable.
And without going too much into details, I think there is a solid, robust evidence that Behind these new recommendations, we have four large randomized trials with Partner 3, Evolut Low Risk, Notion 2, and the Dedicate trial from Germany.
I think as far as I remember, the mean age was something between 71 and 74 years.
meaning that more than 50% were younger than the old age cutoff with 75 years.
TAVI was either non-inferior or superior with regards to the combined clinical endpoint.
So I think there's really a robust evidence for being TAVI as the treatment modality for younger patients.
Before deep diving into those low-risk trials, which I think is important because I think that everybody should understand also the limits of this approach as well as the opportunities, I would like to go back to the guidelines first.
And there is a general tendency to understand that the guidelines support this shift towards younger patients who are now eligible for TAVI.
However, when you read the guidelines carefully, it is clearly stated that there are some constraints and I think we should discuss them.
So when I ask you or you ask me, well, tomorrow, are you gonna do TAVI in a 71 year old patient? In general, the answer is yes, I will definitely consider it.
But for example, in the guidelines, what is said is that this applies mostly for transfemoral TAVI.
With that being said, there are also anatomical issues like LVOT calcium, like bicuspid disease, or annulus dimensions or annulus anatomy, which may be more or less hostile.
Now, when you look at this, these are sort of soft recommendations given in the guidelines, and they're also operator dependent.
So my question to you is, can we give a general recommendation to everybody and all centers in the world to shift towards younger age, or should we also make it a bit center and operator dependent at this stage?
Yeah, well, then the first question, you know, when we look at the title of this conversation, you know, the question is for you today in your center, is TAVI the right choice for a 70-year-old patient?
Let me just, to begin with, just quickly deep dive in the new guidelines that we have received last year at ESC Congress.
And I think there were many interesting novelties with new recommendations, you know, for asymptomatic patients, for patients with bicuspid aortic valve stenosis.
But above all, I think the new age cutoff was proposed to determine treatment strategies that really changed our And I think if the anatomy is suitable, then at least in my center, German Heart Center Munich, TAVI is now standard of care in all the patients over 70 years of age, given that the anatomy is suitable.
And without going too much into details, I think there is a solid, robust evidence that Behind these new recommendations, we have four large randomized trials with Partner 3, Evolut Low Risk, Notion 2, and the Dedicate trial from Germany.
I think as far as I remember, the mean age was something between 71 and 74 years.
meaning that more than 50% were younger than the old age cutoff with 75 years.
TAVI was either non-inferior or superior with regards to the combined clinical endpoint.
So I think there's really a robust evidence for being TAVI as the treatment modality for younger patients.
Before deep diving into those low-risk trials, which I think is important because I think that everybody should understand also the limits of this approach as well as the opportunities, I would like to go back to the guidelines first.
And there is a general tendency to understand that the guidelines support this shift towards younger patients who are now eligible for TAVI.
However, when you read the guidelines carefully, it is clearly stated that there are some constraints and I think we should discuss them.
So when I ask you or you ask me, well, tomorrow, are you gonna do TAVI in a 71 year old patient? In general, the answer is yes, I will definitely consider it.
But for example, in the guidelines, what is said is that this applies mostly for transfemoral TAVI.
With that being said, there are also anatomical issues like LVOT calcium, like bicuspid disease, or annulus dimensions or annulus anatomy, which may be more or less hostile.
Now, when you look at this, these are sort of soft recommendations given in the guidelines, and they're also operator dependent.
So my question to you is, can we give a general recommendation to everybody and all centers in the world to shift towards younger age, or should we also make it a bit center and operator dependent at this stage?
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