• J. Thorac. Cardiovasc. Surg. · Jan 2025

    Transcatheter versus Surgical Aortic Valve Replacement in Patients Younger than 65 Years in the US.

    • Sundos Alabbadi, Michael E Bowdish, Aminah Sallam, Derrick Y Tam, Irsa Hassan, Abirami Kumaresan, Anas H Alzahrani, Alexander Iribarne, Natalia Egorova, and Joanna Chikwe.
    • Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    • J. Thorac. Cardiovasc. Surg. 2025 Jan 9.

    ObjectiveTo characterize trends and outcomes of aortic valve replacement in patients <65 with aortic stenosis between 2013 and 2021.MethodsThis retrospective analysis included 9,557 patients who underwent biological aortic valve replacement in California, New York, and New Jersey from 2013 through 2021. Patients were stratified by approach: transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR). Our primary outcomes were 30-day and 6-year mortality and morbidity (stroke, heart failure rehospitalization, reintervention, and new pacemaker implantation). After propensity score matching, Cox-proportional hazard and Fine-Gray models were used to compare outcomes following TAVR and SAVR.ResultsThe proportion of patients <65 years with aortic stenosis undergoing TAVR versus SAVR increased from 7.1% in 2013 to 54.7% in 2021. After propensity score matching, 30-day mortality was similar between both groups (1.0% vs. 1.5%, p=0.33). TAVR had a higher 6-year mortality (23.3% vs. 10.5%, HR: 2.27; CI: 1.82-2.83; p<0.001). The 30-day rate of new pacemaker implantation was higher after TAVR (10.7 vs. 6.2%, p<0.001). There was no difference in the 6-year cumulative incidence of stroke, heart failure hospitalizations, or reoperations. Multiple sensitivity analyses confirmed these findings.ConclusionsDespite clinical guidelines, the utilization of TAVR has increased in patients <65. TAVR in this population is associated with a higher 6-year mortality and a higher rate of new permanent pacemaker implantation when compared to a matched cohort treated with biologic SAVR. These findings support the need for a randomized controlled trial comparing long-term outcomes of TAVR versus SAVR in patients <65.Copyright © 2025. Published by Elsevier Inc.

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