Patients <65 years at hospitals with higher risk-adjusted TAVR utilization had 2.7-fold higher odds of undergoing TAVR than those at lower-utilization hospitals (median OR 2.69; 95% CI 2.43-3.02).
Cohort (n=13,907)
Yes
Does hospital-level variation influence the use of TAVR versus SAVR in adults younger than 65 years with isolated aortic stenosis?
There is substantial hospital-level variation in the use of TAVR versus SAVR in patients under 65 with isolated aortic stenosis, with nearly half of the lowest-risk patients receiving TAVR despite current guideline recommendations.
Effect estimate: median OR 2.69 (95% CI 2.43-3.02)
Absolute Event Rate: 55.8% vs 44.2%
BACKGROUND: Current guidelines do not recommend transcatheter aortic valve replacement (TAVR) in adults younger than 65 years with isolated aortic stenosis and a life expectancy >10 years. METHODS: This retrospective cohort study was conducted using the Vizient Clinical Database in adults < 65 years with isolated aortic stenosis who underwent aortic valve replacement with a bioprosthetic valve between 2018 and 2023. Hospital-level variation in TAVR vs SAVR was evaluated using multilevel multivariable logistic regression. RESULTS: Among 13,907 aortic valve replacements, 6,142 (44.2%) were surgical (SAVR), and 7,765 (55.8%) were trans-catheter (TAVR). The median hospital TAVR rate was 52.9% (interquartile range IQR: 35.3%-70.7%). Among patients at the lowest surgical risk (predicted mortality < 0.5%), 46.5% underwent TAVR. Patients treated at hospitals with higher risk-adjusted TAVR vs SAVR utilization had a 2.7-fold higher odds of undergoing TAVR than patients treated at hospitals with a lower risk-adjusted rate (median odds ratio, 2.69; 95% confidence interval: 2.43-3.02). Lower-volume hospitals (based on total AVR volume SAVR plus TAVR) performed fewer TAVRs vs SAVRs compared to higher-volume hospitals. Teaching status, Disproportionate Share Hospital Percentage, rurality, and average daily census were not significantly associated with TAVR utilization. CONCLUSIONS: Substantial variation exists in hospital rates of TAVR versus SAVR among patients younger than 65 with isolated aortic stenosis, even after adjusting for patient characteristics. Nearly half of the lowest-risk patients (mortality <0.5%) under the age of 65 underwent TAVR instead of SAVR. These findings suggest that practice patterns and non-clinical factors may influence procedure selection in this population.
Glance et al. (2026) conducted a cohort in isolated aortic stenosis (n=13,907). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Hospital-level variation in TAVR vs SAVR utilization (median OR 2.69, 95% CI 2.43-3.02). Patients <65 years at hospitals with higher risk-adjusted TAVR utilization had 2.7-fold higher odds of undergoing TAVR than those at lower-utilization hospitals (median OR 2.69; 95% CI 2.43-3.02).