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.

Read also: TAVI y fibrilación auricular: ¿Qué anticoagulantes deberíamos usar?

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.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

Dr. Carlos Fava
Dr. Carlos Fava
Member of the Editorial Board of solaci.org

More articles by this author

OPTION Trial: Left Atrial Appendage Closure

Atrial fibrillation ablation is a valid strategy. However, reoccurrence is frequent in these cases, often with asymptomatic presentation. Anticoagulation with warfarin has proven effective in...

TRI-SPA Study: Tricuspid Edge-to-Edge Treatment

Tricuspid regurgitation (TR) is a condition associated with high morbidity and mortality. Currently, surgery is the recommended treatment; however, it carries a high complication...

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

AHA 2024 | VANISH2 Trial

Cardiac defibrillator implants (CDIs) have been shown to improve survival in patients with ischemic cardiomyopathy and ventricular tachycardia (VT). However, approximately one third of...

AHA 2024 | SUMMIT

It has been previously shown that the pharmacological treatment of obesity (semaglutide) can reduce cardiovascular events in patients with cardiac failure (CF) and preserved...

AHA 2024 – BPROAD

Hypertension (elevated blood pressure, BP) is the most common comorbidity among diabetic patients and has been associated with higher cardiovascular risk, though as a...