Editor’s Note: Patient Worthy is honored to share this article, originally written by David St. Denis, President & Director at Anteris Technologies.
Transcatheter aortic valve replacement (TAVR) was originally developed for patients considered too old or medically fragile to undergo open-heart surgery. That population is changing. Today, nearly three in 10 aortic valve replacements among U.S. patients younger than 65 are performed using TAVR.
That shift represents real progress for patients who may benefit from a less invasive procedure and faster recovery. But it also changes the questions patients, families, and heart teams need to ask. A person receiving a replacement valve at 60 may live another 20 or 30 years and be much more active in their daily lives. Successful treatment therefore must account not only for the first procedure, but also for how the valve performs over time, whether the valve can perform at a level younger, more active patients demand, whether another intervention may eventually be needed, and what options will remain available.
Younger Patients Change the Treatment Equation
Aortic stenosis occurs when the aortic valve narrows and cannot open fully, restricting blood flow from the heart to the rest of the body. Severe disease can lead to shortness of breath, chest pain, heart failure, and death.
TAVR transformed treatment by allowing physicians to replace the diseased valve through a catheter rather than open-heart surgery. As evidence accumulated, its use expanded into healthier and younger patients.
For younger patients, however, the decision is more complicated than simply choosing the less invasive procedure. Surgical aortic valve replacement remains an important option, particularly when a patient’s anatomy, other heart conditions, or expected lifespan make surgery a better long-term strategy. Younger patients are also more likely to have bicuspid aortic valves, which have two leaflets instead of the usual three and can make treatment planning more complex.
Age alone therefore cannot determine the best approach. The first valve choice may affect future coronary access, the feasibility of another valve procedure, and whether surgery remains possible later.
Longer Lives Put Valve Performance Under the Microscope
Long-term evidence around TAVR is encouraging, but younger patients introduce a different timeline. Recent seven-year data in low-risk patients found similar rates of structural valve deterioration and reintervention between TAVR and surgery. Structural valve deterioration occurred in 7.3% of TAVR patients compared with 7.6% of surgical patients, while reintervention rates were 6.0% and 5.5%, respectively.
Seven years, however, is very different from the 20 or 30 years that may matter to someone treated in their 50s or early 60s. Additionally, these seven-year data have been accumulated over several iterations of valve platforms, making true long-term data elusive, and clinical results harder to interpret. Consequently, longer-term durability evidence remains limited, making continued follow-up essential.
Other studies have also produced different signals. Six-year data from another low-risk population showed reintervention in 5.5% of TAVR patients versus 3.3% of surgical patients.
These findings do not establish that one treatment is universally better. They instead reinforce the need to consider the individual patient, valve, anatomy, and potential future interventions when planning treatment.
Earlier Detection Could Move the Decision Forward
The lifetime question may become even more important as medicine gets better at detecting aortic stenosis before the disease progresses.
Artificial intelligence is being studied to identify signs of aortic valve disease earlier, potentially helping physicians flag patients who need additional evaluation. Earlier identification could be particularly valuable because patients may not recognize symptoms until the disease has progressed.
At the same time, research is challenging the traditional practice of waiting for symptoms before intervening. New evidence suggests treating severe aortic stenosis before symptoms develop could improve outcomes while reducing lifetime healthcare costs. Progressive cardiac damage which occurs in the later more severe stages of the disease may offer limited opportunity to reverse the damage done, and yet earlier intervention will may only provide positive clinical benefit if the replacement valves restore more physiologically correct function with respect to flow and load on the cardiac system.
Together, these developments could change when patients enter the treatment pathway. Earlier detection and intervention may protect the heart from prolonged damage, but they could also mean patients spend more years living with their first replacement valve. Therefore, the function, not only durability, of these valves becomes critical.
The First Valve Is Becoming a Lifetime Decision
As aortic stenosis care moves toward younger patients and earlier intervention, procedural success alone will provide an increasingly incomplete picture of treatment. The challenge is not only replacing a narrowed valve but managing the disease in a way that supports the heart over the patient’s lifetime.
That means future technologies will need to address what happens after implantation. Restoring more normal blood flow patterns and reducing the strain aortic stenosis places on the heart could become increasingly important goals, alongside valve durability and the ability to preserve future treatment options. For patients, those advances ultimately matter because they have the potential to support not only longer survival, but better heart function and quality of life.
Heart teams will therefore need to consider age, anatomy, overall health, expected lifespan, valve performance, and the potential need for future procedures together. Clinical research will also need to look beyond whether a valve can be implanted safely and examine how treatment affects blood flow, heart recovery, durability, reintervention, and how patients feel and function over time.
TAVR has already changed what is possible for people with aortic stenosis. The next challenge is adapting treatment strategies to patients who may live for decades after their first valve replacement. For someone receiving a valve in their 50s or 60s, the question is no longer simply how to treat aortic stenosis today. It is how today’s treatment can support the heart, and the patient’s quality of life, for the years that follow.
About David St. Denis:
David St. Denis is President and Director of Anteris Technologies. He joined Anteris in 2017 and previously served as Chief Operating Officer, overseeing product development, clinical operations, regulatory affairs, technical operations, and quality. Before Anteris, he held senior leadership roles at Merck and Millennium Pharmaceuticals, now part of Takeda Pharmaceutical Company. He brings extensive experience in healthcare product development, regulatory approval, market access, and commercialization across U.S. and international markets. St. Denis holds degrees from the University of Connecticut and Boston University, as well as an MBA from Babson College.
LinkedIn: https://www.linkedin.com/in/davidstdenis/
