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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Young Transcatheter Aortic Valve Implantation: Shifting Risk and Outcomes
J Hunter Mehaffey1, Vikrant Jagadeesan2, Michael Bowdish3
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV 26501, United States.
Insights
Younger patients (≤65 years) undergoing Transcatheter Aortic Valve Implantation (TAVI) are typically low surgical risk. Careful heart team evaluation is crucial for these patients, considering TAVI
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Transcatheter Aortic Valve Implantation (TAVI) is increasingly used in patients aged 65 and younger.
- These younger patients are often presumed to be at high surgical risk with limited life expectancy.
Purpose of the Study:
- To evaluate the predicted risk, procedural outcomes, longitudinal results, and cost of TAVI in patients 65 years or younger.
- To stratify TAVI outcomes based on predicted mortality risk in this demographic.
Main Methods:
- Analysis of 6,921 patients aged 65 or younger who received TAVI between 2017 and 2024.
- Utilized a simulated Society of Thoracic Surgeons risk model incorporating the Fried frailty index to assess predicted mortality risk (AUC=0.850).
Main Results:
- The median age was 60 years, with 81.3% of procedures being elective and 9.1% involving bicuspid aortic valves.
- The average predicted mortality risk was 4.3%, with 66.2% of patients having a predicted risk below 4%.
- 30-day mortality was 0.7%, with notable complication rates including stroke (1.0%) and new permanent pacemaker (4.1%). 5-year survival was 88% for low/intermediate risk and 78% for high-risk patients.
Conclusions:
- The majority of contemporary patients aged 65 or younger receiving TAVI outside current guidelines present with low surgical risk.
- Findings underscore the necessity for thorough heart team discussions for younger patients undergoing aortic valve replacement (AVR), considering TAVI's cumulative risks.
Objectives:
Recent data suggest that 50% of patients ≤65 years of age undergo transcatheter aortic valve implantation (TAVI). It has also been suggested that these patients are typically high risk with poor life expectancy. We sought to evaluate predicted risk, procedural and longitudinal outcomes, and cost in patients ≤65 years who received TAVI in the Premier Healthcare Database.
Methods:
All patients aged 65 and younger receiving TAVI (2017-2024) were assessed. A predicted risk of index surgical aortic valve mortality model, incorporating the Fried frailty index, was fitted to simulate the Society of Thoracic Surgeons risk model (AUC = 0.850). TAVI outcomes were stratified by predicted risk of mortality.
Results:
A cohort of 6921 patients ≤65 years received TAVI. The median age was 60 years, 81.3% were elective, and 9.1% bicuspid. The average predicted risk was 4.3%, with 66.2% of patients having a predicted risk <4%. A total of 50 patients (0.7%) died within 30 days of the index procedure. Early complications included 41 (0.6%) emergent sternotomies, 182 (2.6%) unplanned coronary interventions, 32 (0.5%) femoral artery repairs, 77 (1.0%) strokes, and 485 (4.1%) new permanent pacemakers. With a median follow-up of 3.3 years, 5-year survival was 88% in low- and intermediate-risk patients and 78% in the high-risk cohort (>8% predicted).
Conclusions:
Most contemporary patients ≤65 years receiving TAVI outside of existing guidelines are of low surgical risk. These findings, in combination with the cumulative longitudinal risks of TAVI, highlight the need for careful heart team discussions for most young patients requiring AVR.
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