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From the Journals

Younger Hearts, Higher Stakes in TAVR

In a study of 139,695 TAVR patients, those under 65 showed a striking 28.2% one-year readmission rate and nearly 10% mortality - ten times higher than their counterparts in previous low-risk trials, suggesting careful patient selection remains crucial for younger candidates.

Conexiant

Patients younger than 65 years who received transcatheter aortic valve replacement experienced 9.9% mortality at 1 year compared with 8.2% among patients aged 65 to 80 years (P < .001), according to a new study.

In the retrospective cohort study, published in JAMA Cardiology, investigators analyzed the outcomes of 139,695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry who underwent balloon-expandable transcatheter aortic valve replacement (TAVR) between August 2019 and September 2023.

After propensity matching, hospital readmission rates remained higher in younger patients compared with older patients after 1 year (28.2% vs 26.8%, P = .03); however, mortality differences were no longer statistically significant (9.9% vs 10.1%, P = .55).

Despite being chronologically younger, these patients showed substantial comorbidities. Among those under 65 years:

  • 68.9% had heart failure within 2 weeks of procedure
  • 32.4% had chronic lung disease
  • 47.3% had diabetes
  • 11.7% were receiving dialysis
  • 25.2% had bicuspid aortic valves.

The findings suggested that cardiologists are following guideline recommendations by reserving TAVR for younger patients with significant comorbidities that may limit life expectancy. This mortality rate was notably 10 times higher compared with patients selected for previous low-risk randomized trials.

Procedural characteristics revealed high success rates:

  • 95.6% transfemoral approach
  • 99.3% implant success
  • Mean procedure time: 71.5 minutes
  • Low complication rates comparable to older patients.

Quality-of-life scores improved significantly following TAVR in both age groups, with mean Kansas City Cardiomyopathy Questionnaire scores increasing by 32.1 points at 30 days and 34.0 points at 1 year in younger patients.

The study was funded by Edwards Lifesciences and included only balloon-expandable valves. The investigators noted limitations including lack of data beyond 1 year and absence of surgical aortic valve replacement comparison groups.

Conflict of interest disclosures can be found in the study.