Patients younger than 65 years who received balloon-expandable valve TAVR for severe aortic stenosis during the low-surgical risk era were more likely to have comorbidities and exhibited higher rates of death and readmission at one year vs. patients aged 65 to 80 years, according to a study presented at TCT 2024 and simultaneously published in JAMA Cardiology.

Megan Coylewright, MD, MPH, FACC, et al., used data on 139,695 patients from the STS/ACC TVT Registry, looking at patients aged 80 years and younger undergoing TAVR from August 2019 to September 2023. They compared both comorbidities and outcomes of patients younger than 65 years (n=13,849, mean age 59.7, 65.5% male) vs. patients aged 65 to 80 years (n=125,846, mean age 74.1, 61.8% male).

Results showed that patients in the younger group were more likely to have a bicuspid aortic valve than those in the older cohort (25.2% vs. 7.6%, respectively; p<0.001). Younger patients were also more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. This group also had poorer baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs. 52.9 [25.8]; p<0.001) and lower mean gait speed (5-meter walk test, 6.6 [5.8] seconds vs. 7.0 [4.9] seconds; p<0.001).

When investigating outcomes at one year, risk of readmission (28.2% vs. 26.2%; p<0.001) and all-cause mortality (9.9% vs. 8.2%; p<0.001) was significantly higher among the younger age group when compared to the older cohort. Even after propensity matching, younger patients maintained higher risk of readmission (28.2% vs. 26.8%; p<0.03) and similar risk of mortality (9.9% vs. 10.1%; p=0.55).

“Current regulatory policies require the participation of a heart team to determine suitability for the procedure,” write the authors. “The prevalence of comorbidities affecting longevity among younger patients in this analysis likely reflects careful case selection by local heart teams.”

In an accompanying editorial comment, Robert O. Bonow, MD, MACC, and Patrick T. O’Gara, MD, MACC, state that “the current study adds to the ongoing discussion of what represents appropriate decision-making in younger patients with limited life expectancy and to what extent there may be indication creep and underscores why further clinical trials in younger patients are needed.”

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: TCT24, National Cardiovascular Data Registries, STS/ACC TVT Registry, Transcatheter Aortic Valve Replacement