Young Transcatheter Aortic Valve Implantation: Shifting Risk and Outcomes

OBJECTIVES: Recent data suggest that 50% of patients ≤65 years of age undergo transcatheter aortic valve implantation (TAVI). It has also been suggested that these patients are typically high risk with poor life expectancy. We sought to evaluate predicted risk, procedural and longitudinal outcomes, and cost in patients ≤65 years who received TAVI in the Premier Healthcare Database. METHODS: All patients aged 65 and younger receiving TAVI (2017-2024) were assessed. A predicted risk of index surgical aortic valve mortality model, incorporating the Fried frailty index, was fitted to simulate the Society of Thoracic Surgeons risk model (AUC = 0.850). TAVI outcomes were stratified by predicted risk of mortality. RESULTS: A cohort of 6921 patients ≤65 years received TAVI. The median age was 60 years, 81.3% were elective, and 9.1% bicuspid. The average predicted risk was 4.3%, with 66.2% of patients having a predicted risk 8% predicted). CONCLUSIONS: Most contemporary patients ≤65 years receiving TAVI outside of existing guidelines are of low surgical risk. These findings, in combination with the cumulative longitudinal risks of TAVI, highlight the need for careful heart team discussions for most young patients requiring AVR.