2.3 Issues Facing TAVR: Lifetime Management and How to Handle the Volume with Expanding Indications in an Aging Population

Problem Presenter: Kristen Skelton

These proceedings summarize the educational activity of the 18th Biennial Meeting of the International Andreas Gruentzig Society held January 27 to 30, 2026, in Puerto Ayora, Santa Cruz, Ecuador.

Faculty Disclosures     Sponsors

2026 IAGS Summary Document

Statement of problem or issue

We have reached a structural heart disease inflection point. Approval of TAVR for asymptomatic severe aortic stenosis reflects an ongoing paradigm shift to proactive disease management.

What we know:

• TAVR now exceeds SAVR in annual operations[1]
• Indications for TAVR are expanding as clinical evidence evolves
• Mitral and tricuspid therapies are accelerating

Lifetime management paradigm

• Initial valve choice determines future options
• Valve durability, coronary artery access, multi-valve sequencing, all matter
• Programs inherit a growing base of valves and repairs requiring surveillance and potential repeat implantation

Capacity mismatch

• Available cath lab time, imaging bandwidth, and structural heart teams are already strained
• Re-interventions require more complex planning and longer procedural times.
• Surveillance burden: serial CT/echo, valve clinics, remote monitoring
• Workforce pipeline for imagers and multi-valve operators is insufficient

Gaps in current knowledge

1. Lifetime management

• Early intervention ≠ Early age
• Median age for TAVR has only fallen from 83 years to 79 years; only 5.1% <65 years
• With recent durability data, how to make care pathways more clear?
• Likelihood of more re-interventions

2. Capacity constraints

• How to “streamline” care?
• Capacity shock or just system inefficiencies?
• Will ambulatory surgery centers be an alternative to full-service hospitals?
• Is the workforce, and the care system, scalable for lifetime load?
• Should structural programs be required to maintain lifetime registries and capacity forecasts?
• How to amplify and take advantage of existing resources?

Possible solutions or future directions

Complete reassessment of the evaluation, management, and treatment decision pathways for structural heart disease will be necessary as growth in demand develops. Adequate clinical infrastructure is not yet in place: Existing infrastructure will need to be expanded where possible as new infrastructure is carefully planned and developed.[2]

References

1. Available at: www.sg2.com/blog/2025/service-line-focus-cardiovascular-care. Accessed March 2, 2026.
2. Cook CM, et al. Proactive Management and Treatment of Aortic Stenosis: An International Expert Perspective. J Am Coll Cardiol. 2026;87(4):414-438. doi: 10.1016/j.jacc.2025.10.074. Epub 2025 Nov 14. PMID: 416364