A rising number of young patients with severe aortic stenosis are choosing to undergo transcatheter aortic valve replacement (TAVR) over surgery, according to new data presented Sunday, Jan. 28, at STS 2024, the annual meeting of the Society of Thoracic Surgeons (STS).
Back in 2020, the American College of Cardiology and American Heart Association issued guidelines that recommended surgical aortic valve replacement (SAVR) instead of TAVR when treating patients younger than 65 years old. This is largely because TAVR patients are more likely to require another intervention over time as they age; implanting a transcatheter heart valve in a younger patient all but ensures they will need a follow-up procedure when they are 80 or 85 years old.
However, as researchers explained at STS 2024, more and more patients are now opting for TAVR over SAVR. The study’s authors evaluated data from more than 37,000 patients who presented with severe aortic stenosis from 2013 to 2021, focusing on a group of 2,360 who required treatment before the age of 60.
Overall, 22% of patients underwent TAVR and 78% underwent SAVR, but the number of patients opting for TAVR increased as the years went on. By 2021, nearly half of patients younger than 60 underwent TAVR.
The study’s authors followed these patients for a median time of 2.4 years after TAVR and 4.9 years after SAVR. Overall, 30-day mortality rates were comparable, but SAVR was linked to a much higher 5-year survival rate (98% vs. 86%). Rates of infective endocarditis, stroke and heart failure hospitalization were comparable.
“While we expected that the volume of transcatheter therapy would increase over the study period in this young patient cohort, we were surprised there appears to be near equipoise in terms of procedure selection, with patients and clinicians opting for procedures against the 2020 guidelines,” co-author Jad Malas, MD, a cardiothoracic surgery resident at Cedars-Sinai Medical Center in Los Angeles, said in a statement.
“As cardiac surgeons, we owe it to our patients to take a more prominent role in providing the highest quality evidence to help our patients make these major healthcare decisions,” added senior author Joanna Chikwe, MD, chair of the department of cardiac surgery in the Smidt Heart Institute at Cedars-Sinai. “While transcatheter therapy appears more attractive to most patients, there are clearly long-term benefits with surgical therapy for the lifetime management of valvular heart disease in many patients.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.