Ktenopoulos N, Milaras N, Apostolos A, Tsioufis C, Toutouzas K, Sideris S. Letter to the Editor: Transcatheter aortic valve implantation beyond 85 years: Age is no longer the limiting factor, but risk stratification still matters. World J Cardiol 2026; 18(7): 117884 [DOI: 10.4330/wjc.117884]
Corresponding Author of This Article
Nikias Milaras, MD, First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Vasilissis Sofias 114, Athens 11527, Greece. nikiasmilaras@gmail.com
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Cardiac & Cardiovascular Systems
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letter
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Ktenopoulos N, Milaras N, Apostolos A, Tsioufis C, Toutouzas K, Sideris S. Letter to the Editor: Transcatheter aortic valve implantation beyond 85 years: Age is no longer the limiting factor, but risk stratification still matters. World J Cardiol 2026; 18(7): 117884 [DOI: 10.4330/wjc.117884]
World J Cardiol. Jul 26, 2026; 18(7): 117884 Published online Jul 26, 2026. doi: 10.4330/wjc.117884
Letter to the Editor: Transcatheter aortic valve implantation beyond 85 years: Age is no longer the limiting factor, but risk stratification still matters
Nikolaos Ktenopoulos, Nikias Milaras, Anastasios Apostolos, Constantinos Tsioufis, Konstantinos Toutouzas, Skevos Sideris, First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens 11527, Greece
Author contributions: Milaras N and Ktenopoulos N conceived the manuscript concept and developed the manuscript framework; Ktenopoulos N drafted the initial version of the manuscript; Milaras N, Apostolos A, Tsioufis C, Toutouzas K, and Sideris S critically revised the manuscript for intellectual content and clinical accuracy. All authors reviewed and approved the final version of the manuscript and agree to be accountable for the content of the work.
AI contribution statement: ChatGPT was only used for language polishing and revising reviewer comments, and the authors have fully reviewed and take full responsibility for the whole paper. No AI was used for data analysis, image creation or reference compilation; all figures and references are independently finished and verified by the authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Nikias Milaras, MD, First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Vasilissis Sofias 114, Athens 11527, Greece. nikiasmilaras@gmail.com
Received: December 18, 2025 Revised: January 19, 2026 Accepted: May 12, 2026 Published online: July 26, 2026 Processing time: 211 Days and 14.7 Hours
Abstract
The rapid expansion of transcatheter aortic valve implantation (TAVI) has fundamentally reshaped the management of severe aortic stenosis in elderly and high-risk populations. However, evidence specifically addressing outcomes in the very elderly, particularly patients aged 85 years and older, needs further exploration. In this context, the retrospective cohort study by Algethami et al provides interesting and clinically relevant insights into mid-term survival following TAVI in this advanced-age group. The authors report favorable survival rates at 1 year and 3 years, reinforcing the concept that chronological age alone should not constitute a contraindication to TAVI. Importantly, their findings highlight obesity as a significant predictor of early mortality, underscoring the need for refined risk stratification beyond conventional age-based decision-making. This article discusses the implications of these results within the evolving landscape of structural heart disease management, emphasizing the shift from age-centered to biology- and comorbidity-driven patient selection. Furthermore, it explores how factors such as frailty, metabolic burden and non-cardiac comorbidities should increasingly inform multidisciplinary heart team decisions. As TAVI continues to expand into older populations, studies such as this one help define realistic expectations, guide individualized care and support evidence-based expansion of indications in the very elderly.
Core Tip: As transcatheter aortic valve implantation expands into younger populations, chronological age alone is no longer an appropriate barrier to intervention. The study by Algethami et al demonstrates favorable mid-term survival in patients aged 85 years and older, reinforcing the safety and feasibility of transcatheter aortic valve implantation in carefully selected individuals. Importantly, the identification of obesity as a predictor of early mortality highlights the limitations of age-based risk scores and underscores the need for biology- and comorbidity-driven patient selection within multidisciplinary heart teams.
