Surgery outperforms TAVR in young heart patients, new data confirm
Transcatheter aortic valve replacement (TAVR) continues to gain momentum as a go-to treatment option for severe, symptomatic aortic stenosis. However, surgical aortic valve replacement (SAVR) remains a significantly safer option for patients 60 years old and younger, researchers confirmed in a new study published in JTCVS Open.[1]
“Current guidelines recommend SAVR for patients younger than 65 years, yet an increasing number of younger patients are undergoing TAVR with uncertain long-term results,” wrote first author Jessan A. Jishu, MD, with the Tulane University School of Medicine, and colleagues. “Given this lack of clarity and growing real-world adoption of TAVR among younger individuals, this study uses a large-scale database representative of practices in the United States to confirm the findings from these previous studies by assessing short- and long-term outcomes of SAVR versus TAVR in patients younger than 60 years, a population in whom long-term durability and reintervention risk are of particular concern.”
Jishu et al. explored the TriNetX database, exploring real-world data from nearly 10,000 patients who underwent TAVR or SAVR from 2006 to 2025. Approximately 80% of patients were treated with SAVR, but TAVR grew more common from 2020 to the end of the study.
Using propensity score matching, the authors landed on two comparable cohorts of 1,666 patients. One group underwent TAVR, and the other group underwent SAVR.
Overall, the two treatment strategies were linked to comparable mortality rates after one month. After one year, however, the mortality rates were 5.5% for SAVR and 7.7% for TAVR. And after five years, the mortality rates were 11.3% for SAVR and 18.3% for TAVR.
After five years, the authors added, SAVR was also linked to lower risks of acute myocardial infarction, endocarditis, complete atrioventricular block, pacemaker implantation, paravalvular leak and reintervention.
“The better outcomes observed with SAVR likely reflect a combination of procedural and patient-specific factors,” the authors wrote. “For instance, surgical valve replacement allows for complete decalcification, which can contribute to lower risk of paravalvular leaks and ultimately reintervention. Patients with coronary artery disease may also benefit from surgical intervention with the option of concomitant coronary revascularization, although the present study analyzed isolated SAVR and did not evaluate that particularly interesting cohort. Furthermore, transcatheter valves exert pressure on nearby conduction tissue and left ventricular outflow tract, contributing to greater rates of atrioventricular block and permanent pacing.”
Reviewing these data as a whole, the group added, these data support SAVR being seen as the “preferred initial aortic valve replacement strategy in this age group, pending confirmation from prospective studies.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.