For patients aged younger than 60 years, transcatheter aortic valve replacement (TAVR) is increasingly used and has overtaken surgical aortic valve replacement (SAVR), despite significantly better survival rates for SAVR, according to a study presented at the annual meeting of The Society of Thoracic Surgeons, held from Jan. 27 to 29 in San Antonio.
Joanna Chikwe, M.D., from the Smidt Heart Institute at Cedars-Sinai in Los Angeles, and colleagues examined clinical practice and midterm outcomes of TAVR and SAVR among patients aged younger than 60 years. Analyses included 2,360 patients who underwent TAVR and SAVR procedures (22.2 and 77.8 percent, respectively), with a median follow-up of 2.4 and 4.9 years, respectively.
The researchers found that the rate of TAVR increased significantly from 7 percent in 2013 to 62 percent in 2021 (annual percent change, 4.7 percent). The 30-day mortality was 0.2 versus 0.4 percent for SAVR versus TAVR. The primary outcome of five-year survival was significantly better for SAVR (98 versus 86 percent). SAVR and TAVR had a similar five-year cumulative incidence of reoperation (2.2 versus 3.8 percent), stroke (1.1 versus 0.8 percent), infective endocarditis (0.8 versus 0.4 percent), and heart failure readmission (1.9 versus 1.2 percent). The five-year survival rate was significantly better after SAVR in propensity score-matched patients (98 versus 88 percent; hazard ratio, 2.5); no significant difference was seen in the cumulative incidence of secondary outcomes.
“We were surprised there appears to be near equipoise in terms of procedure selection, with patients and clinicians opting for procedures against the 2020 guidelines,” coauthor Jad Malas, M.D., also from Cedars-Sinai, said in a statement.
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