ImportanceGuidelines advise heart team assessment for all patients with aortic stenosis, with surgical aortic valve replacement recommended for patients younger than 65 years or with a life expectancy greater than 20 years. If bioprosthetic valves are selected, repeat procedures may be needed given limited durability of tissue valves; however, younger patients with aortic stenosis may have major comorbidities that can limit life expectancy, impacting decision-making.ObjectiveTo characterize patients younger than 65 years who received transcatheter aortic valve replacement (TAVR) and compare their outcomes with patients aged 65 to 80 years.Design, Setting, and ParticipantsThis retrospective registry-based analysis used data on 139 695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, inclusive of patients 80 years and younger undergoing TAVR from August 2019 to September 2023.InterventionBalloon-expandable valve (BEV) TAVR with the SAPIEN family of devices.Main Outcomes and MeasuresComorbidities (heart failure, coronary artery disease, dialysis, and others) and outcomes (death, stroke, and hospital readmission) of patients younger than 65 years compared to patients aged 65 to 80 years.ResultsIn the years surveyed, 13 849 registry patients (5.7%) were younger than 65 years, 125 846 (52.1%) were aged 65 to 80 years, and 101 725 (42.1%) were 80 years and older. Among those younger than 65, the mean (SD) age was 59.7 (4.8) years, and 9068 of 13 849 patients (65.5%) were male. Among those aged 65 to 80 years, the mean (SD) age was 74.1 (4.2) years, and 77 817 of 125 843 patients (61.8%) were male. Those younger than 65 years were more likely to have a bicuspid aortic valve than those aged 65 to 80 years (3472/13 755 [25.2%] vs 9552/125 001 [7.6%], respectively; P < .001). They were more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. Patients younger than 65 years had worse baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs 52.9 [25.8], respectively; P < .001) and mean (SD) gait speed (5-meter walk test, 6.6 [5.8] seconds vs 7.0 [4.9] seconds, respectively; P < .001) than those aged 65 to 80 years. At 1 year, patients younger than 65 years had significantly higher readmission rates (2740 [28.2%] vs 23 178 [26.1%]; P < .001) and all-cause mortality (908 [9.9%] vs 6877 [8.2%]; P < .001) than older patients. When propensity matched, younger patients still had higher 1-year readmission rates (2732 [28.2%] vs 2589 [26.8%]; P < .03) with similar mortality to their older counterparts (905 [9.9%] vs 827 [10.1%]; P = .55).Conclusions and RelevanceAmong US patients receiving BEV TAVR for severe aortic stenosis in the low–surgical risk era, those younger than 65 years represent a small subset. Patients younger than 65 years had a high burden of comorbidities and incurred higher rates of death and readmission at 1 year compared to their older counterparts. These observations suggest that heart team decision-making regarding TAVR for most patients in this age group is clinically valid.

中文翻译：

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低风险时代球囊扩张经导管主动脉瓣置换术对年轻患者的结局


重要性指南建议心脏团队对所有主动脉瓣狭窄患者进行评估，建议 65 岁以下或预期寿命超过 20 岁的患者进行外科主动脉瓣置换术。如果选择生物瓣膜，鉴于组织瓣膜的耐用性有限，可能需要重复手术;然而，年轻的主动脉瓣狭窄患者可能患有主要合并症，这些合并症会限制预期寿命，影响决策。目的对接受经导管主动脉瓣置换术 （TAVR） 的 65 岁以下患者进行特征分析，并将其结局与 65 至 80 岁患者进行比较。设计、设置和参与者这项基于注册的回顾性分析使用了来自胸外科医师协会/美国心脏病学会经导管瓣膜治疗 （TVT） 登记处的 139 695 名患者的数据，包括 2019 年 8 月至 2023 年 9 月接受 TAVR 的 80 岁及以下患者。主要结局和指标与 65 至 80 岁患者相比，65 岁以下患者的合并症（心力衰竭、冠状动脉疾病、透析等）和结局（死亡、中风和再入院）。结果在调查的年份中，13 849 名登记患者 （5.7%） 年龄在 65 岁以下，125 846 名 （52.1%） 年龄在 65 至 80 岁之间，101 725 名 （42.1%） 年龄在 80 岁及以上。在 65 岁以下的人群中，平均 （SD） 年龄为 59.7 （4.8） 岁，13 849 例患者中有 9068 例 （65.5%） 为男性。在 65 至 80 岁的人群中，平均 （SD） 年龄为 74.1 （4.2） 岁，125 843 例患者中有 77 817 例 （61.8%） 为男性。 65 岁以下的人比 65 至 80 岁的人更容易患二叶式主动脉瓣 （分别为 3472/13 755 [25.2%] 和 9552/125 001 [7.6%];P < .001）。他们更有可能患有充血性心力衰竭、慢性肺病、糖尿病、免疫功能低下和接受透析的终末期肾病。65 岁以下患者的基线生活质量较差（平均 [SD] 堪萨斯城心肌病问卷评分分别为 47.7 [26.3] 和 52.9 [25.8];P < .001） 和平均 （SD） 步态速度（5 米步行测试，分别为 6.6 [5.8] 秒和 7.0 [4.9] 秒;P < .001） 比 65 至 80 岁的人群多。1 岁时，65 岁以下患者的再入院率显着更高 （2740 [28.2%] vs 23 178 [26.1%];P < .001） 和全因死亡率 （908 [9.9%] vs 6877 [8.2%];P < .001） 的 10 例 1 例 1 例。当倾向匹配时，年轻患者的 1 年再入院率仍然较高 （2732 [28.2%] vs 2589 [26.8%];P < .03），死亡率与年长的同类相似 （905 [9.9%] vs 827 [10.1%];P = .55）。结论和相关性在低手术风险时代接受 BEV TAVR 治疗严重主动脉瓣狭窄的美国患者中，65 岁以下的患者只占一小部分。与老年患者相比，65 岁以下的患者合并症负担高，1 年死亡率和再入院率更高。这些观察结果表明，对于该年龄组的大多数患者，心脏团队关于 TAVR 的决策在临床上是有效的。