B-8 | Transcatheter Aortic Valve Replacement in Pediatric and Young Adult Patients

Transcatheter aortic valve replacement (TAVR) is well established in the adult population, but there is limited data regarding its use in pediatric and young adult patients. Surgical aortic valve replacement is preferred over TAVR in young patients due to favorable long term data on durability of surgical aortic valve replacements. Our institution has elected to pursue TAVR in these patients who are deemed poor surgical candidates. This is a retrospective cohort study describing the use and short term outcomes of TAVR in pediatric and young adult patients at Texas Children's Hospital/Texas Heart Institute. Twelve patients underwent TAVR betweeen 2018 and 2023 with a mean age of 29 years (range 8-44). Three patients were under 18 years. Indication for TAVR was severe aortic stenosis (AS) in 5 patients and severe aortic regurgitation (AR) in 7 patients. All patients were deemed poor operative candidates. Ventricular assist devices were present in 3 patients. Transfemoral approach was used in 8 patients, transcarotid via surgical cut down in 2 patients, and transapical in 1 patient. Balloon expandable valves were placed in 5 patients (3 young adults and 2 pediatric), and self-expanding valves were placed in 7 (6 young adult and 1 pediatric). Successful deployment occurred in 100% of patients, and all patients survived to discharge. Mild paravalvar leak seen in 3 patients. Average fluoroscopy time was 58 min in pediatric patients and 18.6 min in young adults. At latest follow up (1 month – 8 years), at least moderate AR was seen in 1 patient and at least moderate AS was seen in 2 patients. One patient with a failing Fontan died 14 months post-TAVR due to ventricular fibrillation arrest at home, one hemodialysis-dependent patient developed moderate AS and died during the COVID pandemic, three patients required repeat TAVR, and one underwent heart transplant 3.5 years post-TAVR. Surgical aortic valve replacement remains the optimal treatment strategy for AR or AS in young patients. However, TAVR can be safely performed in those who are poor surgical candidates. While short term outcomes are overall good, longer term follow up is necessary to assess the long term durability of these valves in young patients.