Frontiers in cardiovascular medicine · 2025
Mortality after transcatheter aortic valve replacement in young multimorbid patients as compared to an age-, gender- and comorbidity-matched background population.
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Bække Pernille Steen, Bajoras Vilhelmas, Butt Jawad, Pilgrim Thomas, Montarello Nicholas Joseph, Taramasso Maurizio, Tchetche Didier, Rosseel Liesbeth, Kundelis Ričardas, Česas Kristijonas, Sedaghat Alexander, Sinning Jan-Malte, Adrichem Rik, Miura Mizuki, Erlebach Magdalena, Windecker Stephan, Mylotte Darren, Makkar Raj, Fosbøl Emil, Van Mieghem Nicolas, De Backer Ole
Аннотация
INTRODUCTION: Contrary to the current guidelines patients with symptomatic severe aortic stenosis and ≤65 years of age are often referred for transcatheter aortic valve replacement (TAVR). However, the outcome after TAVR in this patient cohort remains unclear.
OBJECTIVES: This study aimed to assess the rationale for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred for TAVR, to evaluate 3-year all-cause mortality and to compare outcomes with a matched control cohort.
PATIENTS AND METHODS: Retrospective data were collected on all consecutive patients ≤65 years of age with severe aortic stenosis treated with TAVR at 9 centres between 2010 and 2019. The TAVR-population was compared with a 1:4 age-, gender-, and comorbidity-matched population obtained from the Danish National Registries.
RESULTS: The study population consisted of 459 TAVR-recipients and 1,836 matched registry-controls. The main reasons for SAVR denial were prior cardiac surgery (35%), lung disease (30%) and frailty (23%). The 3-year all-cause mortality was 34% in the TAVR-group compared with 8% in the age-, gender- and comorbidity-matched controls with a hazard ratio (HR) of 6.5 (95% CI 4.5-9.6; P < 0.001). Patients undergoing TAVR with an active chronic disease (heart failure, lung disease, dialysis) had a 3-year all-cause mortality HR of 1.8-2.4 compared with controls. Overall, 3-year mortality rates in these distinct TAVR-subgroups were high (30%-50%) irrespective of the underlying condition.
CONCLUSIONS: Young, multimorbid aortic stenosis patients aged ≤65 years and treated with TAVR between 2010 and 2019 have increased medium-term all-cause mortality compared with an age-, gender- and comorbidity-matched background population.
OBJECTIVES: This study aimed to assess the rationale for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred for TAVR, to evaluate 3-year all-cause mortality and to compare outcomes with a matched control cohort.
PATIENTS AND METHODS: Retrospective data were collected on all consecutive patients ≤65 years of age with severe aortic stenosis treated with TAVR at 9 centres between 2010 and 2019. The TAVR-population was compared with a 1:4 age-, gender-, and comorbidity-matched population obtained from the Danish National Registries.
RESULTS: The study population consisted of 459 TAVR-recipients and 1,836 matched registry-controls. The main reasons for SAVR denial were prior cardiac surgery (35%), lung disease (30%) and frailty (23%). The 3-year all-cause mortality was 34% in the TAVR-group compared with 8% in the age-, gender- and comorbidity-matched controls with a hazard ratio (HR) of 6.5 (95% CI 4.5-9.6; P < 0.001). Patients undergoing TAVR with an active chronic disease (heart failure, lung disease, dialysis) had a 3-year all-cause mortality HR of 1.8-2.4 compared with controls. Overall, 3-year mortality rates in these distinct TAVR-subgroups were high (30%-50%) irrespective of the underlying condition.
CONCLUSIONS: Young, multimorbid aortic stenosis patients aged ≤65 years and treated with TAVR between 2010 and 2019 have increased medium-term all-cause mortality compared with an age-, gender- and comorbidity-matched background population.