Trends of Aortic Valve Replacement in Patients 65 Years and Younger in the United States

BACKGROUND Current guidelines recommend surgical aortic valve replacement (SAVR) over transcatheter aortic valve replacement (TAVR) for patients age ≤65 years. Recent state-specific data suggest over 50% of patients age ≤65 years undergo TAVR. Given recent data of a potential survival benefit for mechanical SAVR in patients aged 60 years and younger, we sought to evaluate the national incidence of TAVR, bioprosthetic SAVR, and mechanical SAVR in young patients. METHODS Using the PREMIER Health Database, all patients aged 40-65 years undergoing isolated AVR (2016-2024) were assessed. PREMIER is a nationally representative all-payer, all-age, inpatient and outpatient database accounting for 25% of United States population. Diagnosis-related group and International Classification of Diseases 10th revision procedure codes were used to define procedures and comorbidities and a validated frailty metric. RESULTS A total of 18,694 patients receiving first-time isolated aortic valve replacement were analyzed (31.3% TAVR, 68.7% SAVR). Patients receiving TAVR were older, female, black with higher Kim frailty index (p < 0.0001). Young patients were more likely to receive TAVR at teaching hospitals and larger centers (>499 beds). TAVR increased from the beginning of the study period to a peak of 40.8% in 2020 followed by a decrease to 32.5% in 2024. Overall utilization of mechanical SAVR remained between 15-18% throughout. CONCLUSIONS Nearly one third of patients aged 40-65 years receive TAVR in contemporary practice. Real time data highlight that evolving TAVR use outside of current guidelines is less that previously reported in regional datasets.