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TAVR vs. SAVR: Durability and Bicuspid Aortic Valves with Dr. Kenan Yount

Written By: Allison DeMajistre, BSN, RN, CCRN
Medical Expert: Keenan Yount, MD, Cardiac Surgeon, Mayo Clinic, Jacksonville, Florida
Reviewed By: Adam Pick, Patient Advocate, Author & Website Founder
Published: August 31, 2026

Surgical aortic valve replacement (SAVR) with an open-heart operation used to be the only choice for patients diagnosed with severe aortic stenosis. However, over the last fifteen years, transcatheter aortic valve replacement (TAVR) has gone from an option available only to high-risk surgical patients to one now accessible to patients across all risk categories. Considering TAVR is the least invasive approach and has advantages that include no incisions to the chest or ribs, short hospital stays, and a quick recovery, many patients quickly decide it’s the best treatment for them. At the same time, data continue to accumulate on the long-term outcomes of SAVR versus TAVR, and many questions remain about the safety and durability of each treatment, depending on a patient's age, overall health, and whether the aortic valve is tricuspid or bicuspid.

We recently received a question about this topic from Mark, who asked, “How should a healthy 70-year-old patient with severe aortic stenosis decide between a TAVR and a SAVR procedure? I've seen research that seems to support greater life expectancy for SAVR. Is that correct? Also, would your answer be different if the patient had a bicuspid valve?”

To answer Mark’s question, we spoke with Dr. Kenan Yount, a leading cardiac surgeon at the Mayo Clinic in Jacksonville, Florida. Dr. Yount has performed approximately 2,500 cardiac surgeries, of which 2,000 involved heart valve procedures.

Facts About TAVR vs. SAVR and Durability with Bicuspid Valves

Here are the key insights shared by Dr. Yount:

Deciding on the right treatment requires a team approach. “That’s a great question and one that I get a lot,” said Dr. Yount. “Fortunately, the guidelines leave this open-ended.” He explained that the American Heart Association guidelines for patients aged 65 to 80 call for a true heart team approach, in which the surgeon and cardiologist determine the best path forward based on the patient’s individual goals and whether TAVR or SAVR is preferable.
There isn’t enough long-term data to provide definitive answers. “We’ve seen that at five years there isn’t much difference between the two approaches. At about seven to eight years, though, we’re starting to see surgery take over in certain aspects related to structural valve deterioration, depending on the type of TAVR valve a patient received. But we’re still lacking long-term data on both TAVR and the latest generation of the SAVR valve. So, the honest answer is that we don’t know all the answers. The good news is that either is probably a good approach depending on a patient’s anatomy or other factors that may require a surgical replacement.”
Many of the same variables apply to patients with bicuspid valves. “We’re finding that more patients with bicuspid valves require surgery rather than TAVR, but not all bicuspid valves are the same.” Dr. Yount explained that younger, more active patients with bulky valve calcification may do better with SAVR. Conversely, patients with mild aortic disease who remain active and prefer the least invasive approach may be good candidates for TAVR. “We’re still getting a lot of data, and the 10-year data from the major clinical trials is starting to show inflection points about when surgery may be better than TAVR. We just don’t have it all figured out for each patient quite yet.”

Thanks Dr. Yount and the Mayo Clinic!

On behalf of all the patients in our community, thank you, Dr. Kenan Yount, for everything you and your team are doing at the Mayo Clinic in Jacksonville, Florida!

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

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Video Transcript:

Adam Pick: Hi, everybody. It's Adam with HeartValveSurgery.com, and we're at the American Association for Thoracic Surgery Conference in Chicago, Illinois. I'm thrilled to be joined by Dr. Keenan Yount, who is a leading cardiac surgeon at the Mayo Clinic in Jacksonville, Florida. Dr. Yount, it is great to see you, and thanks for being with me today.

Dr. Kenan Yount: Thanks so much for having me.

Adam Pick: Yeah, so we're here at AATS. We're seeing great presentations and lectures and new research. We're also getting questions from patients all over the country.

This one comes in from Mark, and he asks, "Adam, how should a healthy 70-year-old patient with severe aortic stenosis decide between a TAVR or a SAVR procedure? I've seen research that seems to support greater life expectancy for SAVR. Is that correct?" And the follow-on question, Dr. Yount, is, would your answer be different if the patient had a bicuspid valve?

Dr. Kenan Yount: So that is a great question. It's one I get a lot, and fortunately, the guidelines leave this open-ended. So if somebody between the ages of 65 to 80, uh, the American Heart Association guidelines are to have a true heart team approach, so to meet with a surgeon and a cardiologist and determine the best path forward for a potential patient.

So in other words, involving the patient's goals, the surgeon, and the cardiologist in whether TAVR or SAVR is better for them. it's true that at five years there's, you know, not a lot of difference between the two approaches, and at about seven to eight years, we're starting to see surgery perhaps take over in certain aspects along structural valve deterioration, depending on what kind of TAVR valve a patient got.

but, you know, we're still lacking data. We're still lacking long-term data on both TAVR and the latest generation of the SAVR valve. So the honest answer is people don't know all the answers. Uh, I'd say the good news is either is probably a good approach, uh, depending on the anatomy, depending on other factors that may tip somebody over the edge into needing a surgical replacement.

So a bicuspid valve, you know, by default, probably more and more patients need surgery, we're discovering, than they do TAVR, but not all bicuspid valves are the same. It's very much a spectrum of anatomies. So some people have really bulky calcium, have a younger age, you know, are very active and fit. They may get a better replacement with SAVR.

However, somebody who's got just a mild version of a bicuspid valve or a mild flavor of it, uh, you know, maybe is still very active and wants the least invasive thing done, they might be a good candidate for TAVR. So the answer is totally it depends, and we're still getting more data. We're looking forward to getting 10-year data, uh, from all the major trials, so we're starting to see these inflection points about when surgery may be better than TAVR, and we just don't have it all figured out for each patient yet.

Adam Pick: Yeah. Well, Mark, I hope that helped you. I know it helped me, and on behalf of these folks who are still debating this question of SAVR versus TAVR over the next many years, thanks to you and everything your team are doing at Mayo Clinic in Jacksonville, Florida. Thanks for being with me today and thanks so much for having me and have a great rest of your time here at AATS.

Dr. Kenan Yount: And, and thanks for everything you all do to educate patients as well. I appreciate the opportunity.

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