Transcatheter aortic valve implantation in young patients: a propensity score-matched analysis

Abstract

Abstract Objectives The aim of this study was to assess the reasons for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred to transcatheter aortic valve implantation (TAVI) and to evaluate the 3-year mortality post-TAVI in comparison with a matched background population. Background Data on young multimorbid patients undergoing TAVI is limited, and their prognosis remains unclear. Methods Retrospective data were collected on all consecutive patients ≤65 years with severe, symptomatic aortic stenosis treated with TAVI at 10 different centres in the period 2008 to 2018. Data on three-year vital status were collected. The TAVI population was compared with a 1:4 sex, age, and comorbidity-matched background population obtained from the Danish National Registries. Subgroup analyses included matching of specific comorbidities. Results The study population consisted of 459 TAVI patients and 1836 matched controls from the background population. The primary reasons for SAVR denial were prior cardiac surgery (35%), pulmonary disease (30%), frailty (23%), reduced left ventricular function (19%), renal failure (18%), malignancy/radiation (15%) and obesity (13%). Two-thirds (68%) had more than one reason for SAVR denial. The 3-year risk of mortality was 34% in the TAVI group compared with 3% in the pure sex and age-matched background population with a hazard ratio of 12.6 (CI: 6.2 – 25.6; P < 0.0001). Subgroup analyses will be performed for patients with chronic heart failure, chronic pulmonary disease, chronic dialysis, prior cardiac surgery, prior stroke, and prior Hodgkin’s lymphoma. Conclusion Multimorbid patients aged ≤65 years treated with TAVI in the 2008-2018 period showed satisfactory procedural outcomes. However, mid-term outcomes reveal a poor prognosis with a 3-year mortality of 34%, primarily due to their pre-existing comorbidities.Study Profile