JTCVS open · 2026
Long-term follow-up of surgical versus transcatheter aortic valve replacement in patients younger than 70 years.
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Hernando Del Portillo Juan, Hecht Sébastian, Guiliani Carlos, Cepas-Guillen Pedro, Vidal-Cales Pablo, Kalavrouziotis Dimitri, Dumont Éric, Paradis Jean-Michel, Pibarot Philippe, Rodés-Cabau Josep, Mohammadi Siamak
Аннотация
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) in intermediate- and low-risk patients with severe aortic stenosis. However, most randomized trials have enrolled patients older than 70 years with limited follow-up, and evidence on long-term outcomes in younger populations remains insufficient. Our objective was to compare long-term clinical outcomes between propensity-matched TAVR and SAVR patients aged <70 years.
METHODS: A total of 959 patients (SAVR: 808, TAVR: 151) were included, resulting in 132 propensity-matched patients per group. The primary outcome was a composite of all-cause death, stroke, and procedure- or valve-related hospitalization at 30 days, 2 years, 5 years, and up to 10 years. A flexible parametric survival model was used to evaluate the hazard ratio (HR) for reintervention and its time dynamics.
RESULTS: Baseline characteristics were balanced between matched groups (mean age 64.9 years; Society of Thoracic Surgeons Predicted Risk of Mortality score 2.9%). At 10 years, primary outcome rates were similar (SAVR: 50.8% vs TAVR: 42.9%; HR, 1.01; 95% CI, 0.66-1.53; P = .95). Patients who underwent SAVR had greater rates of acute kidney injury, bleeding, and new-onset atrial fibrillation during hospitalization (P < .01), whereas permanent pacemaker rates were similar (P = .140). Reintervention was more frequent after TAVR (10.6% vs 3.7%; P = .03), and flexible parametric survival model showed a greater risk of reintervention in TAVR (HR, 3.63; 95% CI, 0.73-1.78; P = .01).
CONCLUSIONS: At long-term follow-up, all-cause mortality, stroke, and rehospitalization rates were similar between TAVR and SAVR in patients younger than 70 years with aortic stenosis. However, patients who underwent TAVR had greater rates and risk of reintervention, which did not affect mortality.
METHODS: A total of 959 patients (SAVR: 808, TAVR: 151) were included, resulting in 132 propensity-matched patients per group. The primary outcome was a composite of all-cause death, stroke, and procedure- or valve-related hospitalization at 30 days, 2 years, 5 years, and up to 10 years. A flexible parametric survival model was used to evaluate the hazard ratio (HR) for reintervention and its time dynamics.
RESULTS: Baseline characteristics were balanced between matched groups (mean age 64.9 years; Society of Thoracic Surgeons Predicted Risk of Mortality score 2.9%). At 10 years, primary outcome rates were similar (SAVR: 50.8% vs TAVR: 42.9%; HR, 1.01; 95% CI, 0.66-1.53; P = .95). Patients who underwent SAVR had greater rates of acute kidney injury, bleeding, and new-onset atrial fibrillation during hospitalization (P < .01), whereas permanent pacemaker rates were similar (P = .140). Reintervention was more frequent after TAVR (10.6% vs 3.7%; P = .03), and flexible parametric survival model showed a greater risk of reintervention in TAVR (HR, 3.63; 95% CI, 0.73-1.78; P = .01).
CONCLUSIONS: At long-term follow-up, all-cause mortality, stroke, and rehospitalization rates were similar between TAVR and SAVR in patients younger than 70 years with aortic stenosis. However, patients who underwent TAVR had greater rates and risk of reintervention, which did not affect mortality.