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Guidelines vs Practice: Surgical Versus Transcatheter Aortic Valve Replacement in Adults ≤60 Years
Sundos Alabbadi1, Jad Malas2, Qiudong Chen2
1Department of Population Health Science and Policy at Icahn School of Medicine at Mount Sinai, New York, New York.
The Annals of Thoracic Surgery
|August 23, 2024
Summary
Transcatheter aortic valve replacement (TAVR) use is increasing in younger patients but is linked to worse 5-year survival compared to surgical aortic valve replacement (SAVR). Further trials are needed to clarify optimal treatment for severe aortic stenosis in this age group.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Current guidelines favor surgical aortic valve replacement (SAVR) over transcatheter aortic valve replacement (TAVR) for severe aortic stenosis in patients aged 65 years or younger.
- This study investigates the adoption and outcomes of TAVR versus SAVR in a younger demographic, specifically those aged 60 years or less.
Purpose of the Study:
- To evaluate the clinical practice patterns and patient outcomes for TAVR and SAVR in patients aged 60 years or younger.
- To compare the 5-year survival rates and other key clinical events between TAVR and SAVR in this specific patient population.
Main Methods:
- Analysis of 2360 patients (523 TAVR, 1837 SAVR) aged ≤60 years from 2013-2021 using the California Department of Health Care Access and Information database.
- Propensity score matching was employed to compare outcomes, with a primary endpoint of 5-year survival and secondary endpoints including reoperation, endocarditis, stroke, and heart failure readmissions.
Main Results:
- TAVR utilization in patients ≤60 years increased significantly from 7.2% to 45.7% between 2013 and 2021.
- While 30-day mortality was similar, propensity-matched analysis revealed TAVR was associated with a 2.5-fold increased hazard of 5-year mortality (HR, 2.5; P=.02).
- No significant differences were observed in cumulative incidences of reoperation, stroke, endocarditis, or heart failure readmission between the two procedures.
Conclusions:
- Transcatheter aortic valve replacement (TAVR) adoption is rising among patients aged 60 years or younger in California, nearing surgical aortic valve replacement (SAVR) rates.
- Despite similar short-term outcomes, TAVR is associated with significantly worse 5-year survival in this younger cohort.
- The findings suggest a potential need for randomized controlled trials to establish definitive best practice recommendations for severe aortic stenosis management in patients ≤60 years.
