Could the Age Threshold for TAVI be Relaxed to Below 65 Years? Pros and Cons

Transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for symptomatic severe aortic stenosis (AS) across the whole surgical risk spectrum. Current European guidelines recommend surgical aortic valve replacement (SAVR) for patients less than 75 years of age at low surgical risk, whereas US guidelines advocate for shared decision-making between SAVR and TAVI in patients aged 65 to 80 years, considering life expectancy and valve durability. Although SAVR with mechanical valves offers excellent durability, it is partially offset by significant challenges, including a higher thrombotic risk and the lifelong need for anticoagulation.  
In addition, recent TAVI trials have shown potential benefits for younger, lower-risk populations, generating a growing interest in expanding its indications. Based on these considerations, whether the age threshold for TAVI should be lowered below 65 years of age remains a topic of debate. In this debate, the authors discuss the pros and cons of lowering the age threshold for TAVI.