A STUDY involving 139,695 patients undergoing balloon-expandable valve (BEV) transcatheter aortic valve replacement (TAVR), has demonstrated that patients younger than 65 years exhibit a higher comorbidity burden and significantly greater all-cause mortality and readmission rates, compared to those aged 65 to 80 years. This highlights critical differences in outcomes based on age in patients receiving TAVR for severe aortic stenosis, prompting a reevaluation of clinical approaches for younger patients.
The study utilized a retrospective registry-based analysis from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, which included data from August 2019 to September 2023. Of the total patients, 13,849 (5.7%) were younger than 65 years, while 125,846 (52.1%) were aged 65 to 80 years. The younger cohort had a mean age of 59.7 years, with 65.5% being male, while the older cohort had a mean age of 74.1 years, with 61.8% male. Significant differences in comorbidities were observed; younger patients were more likely to have conditions such as bicuspid aortic valves (25.2% vs. 7.6%), congestive heart failure, chronic lung disease, diabetes, and end-stage kidney disease requiring dialysis. Baseline quality of life was also poorer in younger patients, evidenced by lower Kansas City Cardiomyopathy Questionnaire scores and longer mean gait speeds in the 5-meter walk test. At the one-year mark, younger patients experienced higher readmission rates (28.2% vs. 26.1%) and all-cause mortality (9.9% vs. 8.2%), with these trends persisting even after propensity matching.
These findings underscore the need for careful consideration in the management of younger patients undergoing TAVR. The increased comorbidity burden and adverse outcomes suggest that clinical decision-making must take into account the unique challenges faced by this demographic. Future studies should aim to investigate the underlying factors contributing to these higher rates of mortality and readmission, potentially guiding targeted interventions to improve outcomes. Moreover, clinicians must thoroughly evaluate the risks and benefits of TAVR in younger patients with complex medical histories, ensuring that treatment plans are tailored to optimise patient safety and quality of life.
Reference
Coylewright M et al. Outcomes of balloon-expandable transcatheter aortic valve replacement in younger patients in the low-risk era. JAMA Cardiol. 2024;DOI:10.1001/jamacardio.2024.4237.
