Transcatheter Aortic Valve Replacement (TAVR) & Age: What Should You Know?

Aortic valve stenosis is the most common valvular disease in older adults, according to the National Library of Medicine. By 2050… It is expected that more than eight million people over 90 will have some form of aortic valve stenosis that developed throughout their lifetime, according to Clinical Cardiology. Unfortunately, there is no known therapy to prevent aortic stenosis and the most recommended treatment is a valve replacement. Without a new valve, patients suffer from debilitating symptoms, repeated hospitalizations, heart failure, and death.

For many years, the only option for aortic valve replacement was open-heart surgery, which was often considered much too risky for many older patients. The emergence of transcatheter aortic valve replacement (TAVR) has shifted the outlook for older patients, allowing many to have their aortic valve replaced at a much lower risk. It has also been a game-changer for younger patients in the intermediate and low-risk category, allowing them shorter hospital stays and less recovery time.

Am I Too Old for TAVR? Am I Too Young?

Patients in our community often ask us questions about age and heart valve therapy. I recently spent time with Dr. Raj Makkar, a world-renowned interventional cardiologist at Cedars-Sinai Medical Center in Los Angeles, California. In this video, I had a chance to ask Dr. Makkar about age and TAVR.

Key Learnings About TAVR & Age

Are there any limitations to age and performing a TAVR?

• “First, let’s talk about whether you’re too old to have a TAVR,” said Dr. Makkar. “The answer is, not really.” He explained that if a patient has tight aortic stenosis or a leaky valve but is in good physical condition and takes care of themself, then age alone does not preclude them from having a transcatheter heart procedure. “The recovery from these procedures is relatively fast, and most patients go home the next day,” he said.

Dr. Raj Makkar

• Dr. Makkar said, “As an anecdote, I want to tell you a little story. There was a patient who was 100 years old. He had a tight aortic valve, and he had blockages in critical arteries-the left main and the right coronary artery. This was nearly ten years ago, and when we did his procedure, many people raised their eyebrows and asked why we were doing this on a 100-year-old patient. Guess what? The patient lived to be 106. So, it’s not uncommon for us to do this procedure on patients in their 90s, and we’ve had a few that are 100 or more undergo these transcatheter heart valve procedures. But, the patients need to be viable and able to take care of themselves.”

What about TAVR in young patients?

• “The other end of the spectrum is the very young,” said Dr. Makkar. “And what is very young? Typically, when people are 65 or older, I think there are no questions about transcatheter aortic valve replacement. We have not accumulated the data in younger patients, and I believe it is important for the heart team to explore all options together. Often, these patients are going to need more than one procedure. So, do you start with a TAVR, then do another TAVR 10 years later, and then do surgery? So you begin with surgery, then do TAVR, and then surgery again? I think these are very individualized decisions.
• “There are situations where we’ve done TAVRs in patients who’ve had prior heart valve surgeries when they were very young, and we ended up doing a TAVR procedure when they were in their 20s. So, I think it is a very individualized, case-by-case decision that takes into account age, anatomy, and other clinical aspects.”

Many Thanks to Dr. Makkar and Cedars Sinai Medical Center!

On behalf of patients at HeartValveSurgery.com and patients all over the world, whether they are old or young, thank you, Dr. Makkar, for all the incredible work you and your team are doing at Cedars Sinai in Los Angeles!

Related Links:

• A “Day In The Life” Of An Interventional Cardiologist with Dr. Raj Makkar
• See Dr. Raj Makkar’s Interactive Interventional Cardiologist Profile

Keep on tickin!
Adam

References:

1. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol. 2014;30(9):962-970. doi:10.1016/j.cjca.2014.03.022
2. Galatas C, Afilalo J. Transcatheter aortic valve replacement over age 90: Risks vs benefits. Clin Cardiol. 2019;43(2):156-162. doi:10.1002/clc.23310