TAVI vs SAVR Age Threshold — EECC MCQ

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ModerateValvular Heart DiseaseTAVI vs SAVR Age ThresholdEECC

A 60-year-old man with symptomatic severe aortic stenosis is assessed by the Heart Team. His STS-PROM is 1.5% (low surgical risk) and he is 60 years old. According to the 2025 ESC VHD Guidelines, what is the preferred intervention?

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Correct answer: B — SAVR is recommended for patients <70 years at low surgical risk — the 2025 guidelines set the age threshold for TAVI recommendation at ≥70 years; below 70, SAVR remains the standard of care due to longer-term durability data

The 2025 ESC/EACTS VHD Guidelines updated the age-based recommendations for AVR in severe AS: (1) Age ≥70 years: TAVI recommended (Class I) for patients with tricuspid AV and suitable anatomy, irrespective of surgical risk — based on DEDICATE-DZHK6, NOTION-2, and low-risk trial data; (2) Age <70 years: SAVR recommended (Class I) at low surgical risk — because: (a) TAVI valve durability data beyond 10 years are limited; (b) younger patients will likely outlive a TAVI valve and need reintervention; (c) SAVR has established 15-20 year outcomes; (d) redo SAVR after TAVI is technically challenging. For patients aged 60-70 with intermediate risk, the Heart Team decision considers lifetime valve management, coronary anatomy, vascular access, and patient preference.

Reference: ESC/EACTS (2025): VHD Guidelines