Three-year outcomes following TAVR in younger (<75 years) low-surgical-risk severe aortic stenosis patients

Authors

Thomas Modine, Centre Hospitalier Universitaire de Bordeaux, L'Unité Médico-Chirurgicale des Valvulopathies, Chirurgie Cardiaque, Université de Bordeaux, France (T.M.).
Didier Tchétché, Clinique Pasteur, Toulouse, France (D.T., P.B.).
Nicolas M. Van Mieghem, Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (N.M.V.M., R.A.).
G Michael Deeb, Department of Cardiac Surgery and Division of Interventional Cardiology, Michigan Medicine Health Systems - University Hospital, Ann Arbor, MI. (G.M.D.).
Stanley J. Chetcuti, Department of Internal Medicine and Division of Cardiovascular Medicine, Michigan Medicine Health Systems - University Hospital, Ann Arbor, MI. (S.J.C.).
Steven J. Yakubov, Department of Cardiology, Ohio Health Riverside Methodist Hospital, Columbus (S.J.Y.).
Paul Sorajja, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.S.).
Hemal Gada, Department of Interventional Cardiology and Cardiothoracic Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle Health, Harrisburg, PA (H.G., M.M.).
Mubashir Mumtaz, Department of Interventional Cardiology and Cardiothoracic Surgery, University of Pittsburgh Medical Center, Moffitt Heart/Pinnacle Health, Harrisburg, PA (H.G., M.M.).
Basel Ramlawi, Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, PA (B.R.).
Tanvir Bajwa, Advocate Health - MidwestFollow
John Crouch, Advocate Health - MidwestFollow
Paul S. Teirstein, Department of Interventional Cardiology, Scripps Clinic, Scripps Prebys Cardiovascular Institute, La Jolla, CA (P.S.T.).
Neal S. Kleiman, Department of Interventional Cardiology and Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K., M.J.R.).
Ayman Iskander, Saint Joseph's Hospital Health Center, Syracuse, NY (A.I.).
Rodrigo Bagur, London Health Sciences Centre - University Campus, Ontario, Canada (R.B., M.W.A.C.).
Michael W. Chu, London Health Sciences Centre - University Campus, Ontario, Canada (R.B., M.W.A.C.).
Pierre Berthoumieu, Clinique Pasteur, Toulouse, France (D.T., P.B.).
Arnaud Sudre, Centre Hospitalier Régional Universitaire de Lille, France (A.S.).
Rik Adrichem, Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (N.M.V.M., R.A.).
Saki Ito, Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN (S.I.).
Jian Huang, Medtronic, Mounds View, MN (J.H., J.J.P.).
Jeffrey J. Popma, Medtronic, Mounds View, MN (J.H., J.J.P.).
John K. Forrest, Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT (J.K.F.).
Michael J. Reardon, Department of Interventional Cardiology and Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K., M.J.R.).

Recommended Citation

Modine T, Tchétché D, Van Mieghem NM, et al. Three-Year Outcomes Following TAVR in Younger (<75 Years) Low-Surgical-Risk Severe Aortic Stenosis Patients. Circ Cardiovasc Interv. Published online October 18, 2024. doi:10.1161/CIRCINTERVENTIONS.124.014018

Affiliations

Aurora St. Luke's Medical Center

Abstract

Background:Transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis, but data are limited on younger, low-risk patients. This analysis compares outcomes in low-surgical-risk patients aged <75 years receiving TAVR versus surgery.

Methods:The Evolut Low Risk Trial randomized 1414 low-risk patients to treatment with a supra-annular, self-expanding TAVR or surgery. We compared rates of all-cause mortality or disabling stroke, associated clinical outcomes, and bioprosthetic valve performance at 3 years between TAVR and surgery patients aged <75 years.

Results:In patients <75 years, 352 were randomized to TAVR and 351 to surgery. Mean age was 69.1±4.0 years (minimum 51 and maximum 74); Society of Thoracic Surgeons Predicted Risk of Mortality was 1.7±0.6%. At 3 years, all-cause mortality or disabling stroke for TAVR was 5.7% and 8.0% for surgery (P=0.241). Although there was no difference between TAVR and surgery in all-cause mortality, the incidence of disabling stroke was lower with TAVR (0.6%) than surgery (2.9%; P=0.019), while surgery was associated with a lower incidence of pacemaker implantation (7.1%) compared with TAVR (21.0%; P<0.001). Valve reintervention rates (TAVR 1.5%, surgery 1.5%, P=0.962) were low in both groups. Valve performance was significantly better with TAVR than surgery with lower mean aortic gradients (P<0.001) and lower rates of severe prosthesis-patient mismatch (P<0.001). Rates of valve thrombosis and endocarditis were similar between groups. There were no significant differences in rates of residual ≥moderate paravalvular regurgitation.

Conclusions:Low-risk patients <75 years treated with supra-annular, self-expanding TAVR had comparable 3-year all-cause mortality and lower disabling stroke compared with patients treated with surgery. There was significantly better valve performance in patients treated with TAVR.

Type

Article

PubMed ID

39421943