Transcatheter Versus Surgical Aortic Valve Replacement in Patients Aged 50 to 64 Years in the United States

Outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients aged 50-64 years have not been evaluated in randomized clinical trials. Despite the lack of randomized data, these patients are often treated with TAVR.

We queried the Nationwide Readmissions Database (2016-2021) to identify patients aged 50-64 years hospitalized for isolated aortic valve replacement (AVR). The contemporary use of TAVR and SAVR in patients aged 50-64 years was evaluated. In-hospital outcomes of TAVR vs SAVR were compared using propensity score matching. Readmissions were compared using the Cox proportional hazards regression model.

Of 75,413 weighted hospitalizations for isolated AVR in patients aged 50-64 years, 22,695 (30.1%) included TAVR, and 52,718 (69.9%) included SAVR. From 2016Q1 to 2021Q4, the proportion of AVR performed using TAVR increased from 12.6% to 41.4% in patients aged 50-64 years (p_trend < .001). TAVR, compared with SAVR, was associated with lower in-hospital mortality (1.0% vs 2.0%; P < .001), stroke (1.4% vs 2.8%; P < .001), acute kidney injury (9.8% vs 17.4%; P < .001), and major bleeding (1.0% vs 1.4%, P = .04) and with higher permanent pacemaker placement (4.7% vs 3.4%; P < .001), vascular complications (3.5% vs 1.6%; P < .001), and 180-day all-cause readmissions (14.4% vs 9.0%; P < .001). Length of stay was shorter (2 vs 6 days; P < .001) and nonhome discharges were lower (17.1% vs 54.6%; P < .001) with TAVR than those with SAVR.

This nationwide observational analysis found that TAVR is increasingly performed among patients aged 50-64 years with lower in-hospital mortality and resource utilization but higher readmissions than SAVR.