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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
Revised: January 19, 2026
Accepted: May 12, 2026
Published online: July 26, 2026
Processing time: 211 Days and 14.7 Hours
Core Tip
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.