European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026
Young Transcatheter Aortic Valve Implantation: Shifting Risk and Outcomes.
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Mehaffey J Hunter, Jagadeesan Vikrant, Bowdish Michael, Chauhan Dhaval, Hayanga J W Awori, Mascio Christopher E, Price Bradley S, Daggubati Ramesh, Badhwar Vinay
Аннотация
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.
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.