TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups.

While previous analyses have generally included patients over 75 years old with encouraging results, this strategy has not been sufficiently assessed in younger patients.

Researchers conducted an analysis of the Evolut Low Risk Study including patients under 75 years old. In total, the analysis included 703 patients, of whom 352 underwent TAVR and the rest had surgery.

The groups were similar in characteristics. The average age was 69 years and 37% of the patients were women. The STS score was 1.7%, with a prevalence of diabetes at 37%, hypertension at 85%, peripheral vascular disease at 8%, chronic obstructive pulmonary disease (COPD) at 20%, cerebrovascular disease at 10%, coronary revascularization surgery at 3%, acute myocardial infarction at 5.5%, and atrial fibrillation in 12% of cases.

The average ventricular function was 61%, the aortic valve area was 0.8 cm², with a peak velocity of 4.2 m/s and a mean gradient of 46 mmHg.

At 30 days, there were no significant differences in all-cause mortality or disabling stroke. However, surgery showed a higher incidence of atrial fibrillation, impaired renal function, and major or life-threatening bleeding, whereas the TAVR group had more conduction disorders and a higher need for pacemakers.

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At 3 years of follow-up, there were no significant differences in all-cause mortality or disabling stroke (5.7% for TAVR vs. 8.0% for surgery; P=0.241). All-cause mortality was similar between the two groups (5.1% for TAVR vs. 5.7% for surgery), but the incidence of disabling stroke was higher in patients who underwent surgery (0.6% for TAVR vs. 2.9% for surgery; P=0.019). There were no differences in terms of myocardial infarction or valve thrombosis, but the need for a pacemaker was significantly higher for patients in the TAVR group (21% vs. 7%; P<0.001).

In Doppler echocardiography, the aortic valve area was larger in patients who underwent TAVR (2.2 cm² vs. 1.9 cm²; P <0.001), who also had a lower mean gradient (9.7 mmHg vs. 12.7 mmHg; P <0.001). However, paravalvular regurgitation was more frequent in the TAVR group, although the difference did not reach statistical significance.

Conclusion

In low-risk patients under 75 years of age treated with a self-expanding supra-annular percutaneous valve, at 3 years of follow-up, all-cause mortality and disabling stroke events were comparable with those in patients who had undergone surgery, although the incidence of disabling stroke was lower for subjects in the TAVR group. Additionally, valve performance was significantly better in patients who underwent TAVR.

Original Title: Three-Year Outcomes Following TAVR in Younger (<75 Years) Low-Surgical-Risk Severe Aortic Stenosis Patients.

Reference: Thomas Modine, et al. Circ Cardiovasc Interv. 2024;17:e014018. DOI: 10.1161/CIRCINTERVENTIONS.124.014018.