Surgical versus transcatheter aortic valve replacement in patients age <65 years.

Background: American College of Cardiology/American Heart Association guidelines include a class I indication for surgical aortic valve replacement (SAVR) over transcatheter aortic valve replacement (TAVR) in patients age <65 years. This analysis assessed outcomes of SAVR versus TAVR in patients <65 years. Methods: This was a retrospective, single-institution study of consecutive SAVRs and TAVRs performed between 2013 and 2023. Patients age <65 years were included, and those who underwent concomitant operations or prior AVR were excluded. To balance the AVR cohorts, propensity score matching (PSM) was performed using a 1:1 match ratio. Short-term clinical and echocardiographic outcomes were compared. Kaplan-Meier survival estimation and Fine-Gray analysis of heart failure readmission were performed to evaluate mid-term outcomes after AVR. Results: A total of 761 patients age <65 years underwent AVR, including 655 with SAVR and 106 with isolated TAVR. PSM yielded a cohort of 97 SAVR patients and 97 TAVR patients age <65. After matching, the 2 groups were acceptably balanced across all baseline variables. No significant differences were observed in most immediate postoperative complications. Kaplan-Meier survival estimates were significantly lower for those who underwent TAVR, with 5-year survival rates of 46.3% for TAVR versus 79.7% for SAVR (P < .01). The cumulative incidence of heart failure readmissions was significantly higher in the TAVR group, with a 5-year incidence of 43.1% versus 20.8% in matched SAVR patients (P < .01). Conclusions: TAVR was significantly associated with decreased mid-term survival and increased heart failure readmissions compared to SAVR in patients age <65 years.