Trends of Aortic Valve Replacement in Patients 65 Years and Younger in the United States

Current guidelines recommend surgical aortic valve replacement (SAVR) over transcatheter aortic valve replacement (TAVR) for patients ≤65 years of age. Recent state-specific data suggest that >50% of patients aged ≤65 years undergo TAVR. Given recent data of a potential survival benefit for mechanical SAVR in patients aged 60 years and younger, we sought to evaluate the national incidence of TAVR, bioprosthetic SAVR, and mechanical SAVR in young patients.

Using the Premier Healthcare Database, all patients aged 40 to 65 years undergoing isolated aortic valve replacement (2016-2024) were assessed. Premier is a nationally representative all-payer, all-age, inpatient and outpatient database accounting for 25% of the population of the United States. Diagnosis-related group and International Classification of Diseases, Tenth Revision procedure codes were used to define procedures and comorbidities and a validated frailty metric.

A total of 18,694 patients receiving first-time isolated aortic valve replacement were analyzed (31.3% TAVR, 68.7% SAVR). Patients receiving TAVR were older and more often female and Black, with higher Kim frailty index (P < .0001). Young patients were more likely to receive TAVR at teaching hospitals and larger centers (>499 beds). TAVR increased from the beginning of the study period to a peak of 40.8% in 2020, followed by a decrease to 32.5% in 2024. Overall utilization of mechanical SAVR remained between 15% and 18% throughout.

Nearly one-third of patients aged 40 to 65 years receive TAVR in contemporary practice. Real-time data highlight that evolving TAVR use outside of current guidelines is less than previously reported in regional data sets.