Mortality after transcatheter aortic valve replacement in young multimorbid patients as compared to an age-, gender- and comorbidity-matched background population

Introduction: 

Contrary to the current guidelines patients with symptomatic severe aortic stenosis and ≤65 years of age are often referred for transcatheter aortic valve replacement (TAVR). However, the outcome after TAVR in this patient cohort remains unclear. 

Objectives: 

This study aimed to assess the rationale for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred for TAVR, to evaluate 3-year all-cause mortality and to compare outcomes with a matched control cohort. 

Patients and methods: 

Retrospective data were collected on all consecutive patients ≤65 years of age with severe aortic stenosis treated with TAVR at 9 centres between 2010 and 2019. The TAVR-population was compared with a 1:4 age-, gender-, and comorbidity-matched population obtained from the Danish National Registries. 

Results: 

The study population consisted of 459 TAVR-recipients and 1,836 matched registry-controls. The main reasons for SAVR denial were prior cardiac surgery (35%), lung disease (30%) and frailty (23%). The 3-year all-cause mortality was 34% in the TAVR-group compared with 8% in the age-, gender- and comorbidity-matched controls with a hazard ratio (HR) of 6.5 (95% CI 4.5–9.6; P < 0.001). Patients undergoing TAVR with an active chronic disease (heart failure, lung disease, dialysis) had a 3-year all-cause mortality HR of 1.8–2.4 compared with controls. Overall, 3-year mortality rates in these distinct TAVR-subgroups were high (30%–50%) irrespective of the underlying condition. 

Conclusions: 

Young, multimorbid aortic stenosis patients aged ≤65 years and treated with TAVR between 2010 and 2019 have increased medium-term all-cause mortality compared with an age-, gender- and comorbidity-matched background population.