Transcatheter Versus Surgical Aortic Valve Replacement in Women of Childbearing Age in the United States.

BACKGROUND

Women of childbearing age occasionally require aortic valve replacement (AVR), sometimes performed with transcatheter AVR (TAVR). Outcomes of TAVR versus surgical AVR (SAVR) in women of childbearing age have not been evaluated. We aimed to evaluate the contemporary use and outcomes of TAVR versus SAVR in women of childbearing age in the United States.

METHODS

Women aged 18-50 years hospitalized for isolated AVR were identified in the Nationwide Readmissions Database (2016-2022). In-hospital outcomes of TAVR versus SAVR were compared using propensity-score matching. Readmissions were compared using the Cox proportional hazards regression model.

RESULTS

Of 6926 weighted hospitalizations for isolated AVR in women aged 18-50 years, 897 (13.0%) included TAVR, and 6029 (87.0%) included SAVR. From 2016-2022, the proportion of AVR performed using TAVR increased from 7.4% to 16.3% in women aged 18-50 years (ptrend<0.001). Compared with SAVR, TAVR was associated with lower in-hospital mortality (<1.4 vs. 3.5%, p = 0.03), acute kidney injury (9.0 vs. 16.8%, p = 0.002), and need for blood transfusion (7.1 vs. 19.1%, p ​< ​0.001), but higher heart block (23.5 vs. 9.7%, p ​< ​0.001) and vascular complications (5.0 vs. 2.1%, p = 0.03). Length of stay was shorter (2 vs. 7 days, p ​< ​0.001) and nonhome discharges were lower (16.2 vs. 56.7%, p ​< ​0.001) with TAVR compared with SAVR. Ninety-day all-cause readmissions were similar between TAVR and SAVR (12.6 vs. 13.3%, p = 0.78).

CONCLUSIONS

This nationwide observational analysis found that TAVR is increasingly performed among women aged 18-50 years with lower in-hospital mortality and resource utilization and similar readmissions compared with SAVR.