In-hospital outcomes after transcatheter or surgical aortic valve replacement in younger patients less than 75 years old: a propensity-matched comparison

Aims: Randomised trials comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) have included mainly elderly patients >80 years. The authors aimed to investigate comparative in-hospital outcomes of younger patients <75 years old undergoing transfemoral (TF) TAVR or isolated SAVR. Methods and results: A total of 6,972 patients aged 65-74 years undergoing TF-TAVR or SAVR between 2013 and 2014 were identified from the observational German Quality Assurance Registry on Aortic Valve Replacement (AQUA), which comprises all TAVR and SAVR procedures performed in Germany. Analyses were performed for the overall unmatched cohort as well as for 1,388 propensity-matched patients. Overall, 82.4% of patients <75 years needing treatment for aortic valve stenosis received SAVR. Patients undergoing TF-TAVR were older and had more comorbidities with higher predicted risk of death. After propensity matching, in-hospital mortality (1.3% vs. 1.9%, p=0.39), stroke/TIA (1.0% vs. 2.1%, p=0.09), and myocardial infarction (0 vs. 0.3%, p=0.16) were not different after TF-TAVR or SAVR. Postoperative delirium was more frequent after SAVR (8.9% vs. 2.4%, p<0.001), whereas the need for a new pacemaker was four times higher after TF-TAVR (13.3% vs. 3.5%, p<0.001). Conclusions: Younger patients <75 years old undergoing TF-TAVR or SAVR had similar outcomes with the exception of a more frequent need for new pacemaker implantation and a less frequent incidence of postoperative dialysis and delirium in TF-TAVR patients. Whether these similar in-hospital outcomes are replicable in the longer-term events in TF-TAVR and SAVR remains to be proven in future studies.