Aortic Stenosis Mortality Increased After Broad FDA Approval of TAVR

Delays in diagnosis, long waits for operations may explain trend

Jan. 30, 2026 at 5:55pm

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A nationwide study found a small but alarming increase in aortic stenosis (AS) mortality rates among people ages 45 to 74 starting in 2019, coinciding with the expansion of transcatheter aortic valve replacement (TAVR) into low-risk populations. The researchers suggest this may be due to delays in diagnosis, prolonged wait times, and uncertainty regarding optimal timing of intervention, particularly for younger or asymptomatic patients.

Why it matters

The rise in AS mortality in the younger age group is concerning and demands urgent evaluation of existing screening practices, timely diagnosis, and equitable access to both transcatheter and surgical therapies. As TAVR indications continue to evolve, shared decision-making must consider not only procedural risk but also anticipated lifetime valve strategy and equitable access to timely intervention.

The details

The study found that in the 45-74 age group, age-adjusted AS mortality rates had been relatively stable until 2019, when they started climbing from 3.33 per 100,000 to 3.57 per 100,000 in 2023. In contrast, those ages 75 and older showed a consistent decline in age-adjusted AS mortality rates from 2012 to 2023. The researchers suggest this may be due to the expansion of TAVR into low-risk populations, which could introduce delays in diagnosis, prolonged wait times, and uncertainty regarding optimal timing of intervention, particularly for younger or asymptomatic patients. Hospital capacities to perform TAVR have also not kept up with the ballooning demand, resulting in longer wait times.

  • From 1992 to 2023, the researchers analyzed nationwide data on deaths where aortic stenosis was listed as an underlying or contributing cause.
  • In the cohort of patients ages 45 to 74, age-adjusted AS mortality rates appeared to decrease sharply from 1999 to 2005, after which they remained relatively stable until 2019.
  • The small increase in AS mortality in the younger group started in 2019, coinciding with the expansion of TAVR into low-risk populations.

The players

Sameer Hirji, MD, MPH

Researcher at Brigham and Women's Hospital in Boston who presented the study at the Society of Thoracic Surgeons (STS) annual meeting.

CDC WONDER database

The database used by the researchers to analyze nationwide trends in aortic stenosis mortality.

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What they’re saying

“This emerging trend -- spanning sex, race, and geography -- demands urgent evaluation of existing screening practices, timely diagnosis, and equitable access to both transcatheter and surgical therapies.”

— Sameer Hirji, MD, MPH, Researcher (MedPage Today)

“If these trends grow, it may be important to revisit these guidelines.”

— Sameer Hirji, MD, MPH, Researcher (MedPage Today)

“Importantly, younger patients may experience prolonged periods of surveillance before intervention, especially when asymptomatic, potentially increasing cumulative exposure to left ventricular pressure overload.”

— Sameer Hirji, MD, MPH, Researcher (MedPage Today)

What’s next

The researchers plan to further investigate the factors contributing to the increase in aortic stenosis mortality in the younger age group, including the impact of the COVID-19 pandemic and the evolving landscape of TAVR procedures.

The takeaway

The rise in aortic stenosis mortality among younger adults highlights the need for improved screening, timely diagnosis, and equitable access to both surgical and transcatheter therapies. As TAVR becomes more widely adopted, healthcare systems must ensure they can meet the growing demand and provide optimal care to patients, particularly those who may be asymptomatic or at lower risk.