Structural Heart Interventions Continue To Grow With Promising Results

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure used to replace damaged heart valves, offering patients an alternative to open heart surgery. Over the last decade, there has been a dramatic shift in the treatment of valvular heart disease, and today, the majority of patients with aortic stenosis who undergo aortic valve replacement have a TAVR procedure.

A new study led by Yale investigators demonstrated that patients with severe aortic stenosis treated with TAVR have comparable five-year outcomes to those treated with surgical aortic valve replacement (SAVR). The study was published in the Journal of the American College of Cardiology on March 30, and was presented as a late-breaking study at the 2025 American College of Cardiology (ACC) Annual Scientific Session.

These results are the latest from the Evolut Low Risk clinical trial. The trial randomly assigned patients with severe aortic stenosis and low surgical risk to either TAVR or SAVR to replace their aortic valves and compared outcomes.

“The short-term benefits of TAVR—including an average hospital stay of one night—are clear,” says John K. Forrest, MD, professor of medicine (cardiovascular medicine) and director of the Structural Heart Disease program at Yale. “However, in younger, low-risk patients, it is also critical that we understand the durability and longer-term outcomes of TAVR.” Forrest is the national co-principal investigator of the trial and lead author of the study.

The study demonstrated that after five years of follow-up, 15.5% of the people in the study treated with TAVR had all-cause mortality or disabling stroke compared to 16.4% of the people treated with SAVR. Similarly, cardiovascular mortality was 7.2% in the TAVR group and 9.3% in the SAVR group. Both groups of patients (a total of 1,414 patients) reported a sustained improvement in quality of life.

“These data further establish TAVR as an excellent option for the treatment of patients with severe aortic stenosis regardless of their surgical risk,” says Forrest.

Yale performed the first TAVR in Connecticut nearly fifteen years ago. Since then, Yale has continued to invest in research, people, and technology to bring TAVR and other minimally invasive procedures to more patients with valvular and structural heart disease. Earlier this year, a team of cardiologists and cardiac surgeons at Yale New Haven Hospital performed the state’s first BATMAN (Balloon-Assisted Translocation of the Mitral Anterior Leaflet) procedure, offering hope to patients with mitral valve disease.

Yale New Haven Hospital recently invested in a new hybrid cardiac structural lab dedicated to performing TAVR and other complex cardiac procedures. Yale has also expanded its multidisciplinary team by adding Amit Vora, MD, MPH, assistant professor of medicine (cardiovascular medicine), a skilled interventional cardiologist. Additionally, Yale has hired highly specialized cardiac imagers with expert training in the techniques needed to give interventionists and cardiac surgeons a three-dimensional view of the patient’s heart during procedures.

“We are investing in the people and technology necessary to build one of the strongest structural heart disease programs in the country,” says Eric J. Velazquez, MD, Robert W. Berliner Professor of Medicine (cardiovascular medicine) and chief of Yale Cardiovascular Medicine. “Our faculty participate in the earliest stages of basic and clinical research, allowing us to train fellows in the most innovative procedures and offer our patients cutting-edge treatments through clinical trials and commercial therapies as soon as they become available. Our strong partnerships with colleagues in cardiac surgery, radiology, and anesthesiology, who are fully committed to the growth of this program under Dr. Forrest’s visionary leadership, position us well to remain in this growing field into the future.”

Yale School of Medicine started one of the first structural heart fellowships in the United States and provides dedicated training to fellows each year in advanced procedures.

“The fellows in this advanced program would otherwise be out in the world, performing standard procedures on patients,” says Forrest. “But our structural heart fellows come to Yale to gain expertise in extremely complex or novel procedures and to learn new techniques still in the early stages of clinical trials.”

One of those early-stage clinical trials is the CORCINCH-HF Study, led by Lavanya Bellumkonda, MD, associate professor of medicine (cardiovascular medicine). This study is evaluating the safety and efficacy of a new heart failure treatment that uses a small ventricular remodeling device to cinch the heart and make it smaller. Yale New Haven Hospital was the first in New England to perform the innovative minimally invasive AccuCinch procedure several years ago.

“Patients understand that novel treatments like these may or may not be successful. We explain why we think and hope it will work, but patients also understand that we are going to try something no one has ever tried before,” says Forrest. “It’s one of the most rewarding parts of academic medicine—the chance to offer new treatments that can change lives.”

The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.