Key result
TAVR linked to ~50% lower in-hospital mortality but higher readmissions vs SAVR in younger patients.
Why the study?
Outcomes of TAVR versus SAVR in patients aged 50-64 years have not been evaluated in randomized clinical trials, yet these patients are often treated with TAVR.
Does transcatheter aortic valve replacement improve in-hospital outcomes and reduce readmissions compared to surgical aortic valve replacement in patients aged 50 to 64 years?
Observational (n=75,413)
Yes
Does transcatheter aortic valve replacement improve in-hospital outcomes and reduce readmissions compared to surgical aortic valve replacement in patients aged 50 to 64 years?
Absolute Event Rate: 1% vs 2%
p-value: p=<0.001
In patients aged 50-64 years undergoing isolated AVR, TAVR was associated with lower in-hospital mortality and shorter length of stay but higher 180-day readmissions compared to SAVR.
Caution against favoring TAVR in patients aged 50-64; observational data leaves open whether net benefit exceeds SAVR in randomized trials.
Abstract Background Outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients aged 50-64 years have not been evaluated in randomized clinical trials. Despite the lack of randomized data, these patients are often treated with TAVR. Methods We queried the Nationwide Readmissions Database (2016-2021) to identify patients aged 50-64 years hospitalized for isolated aortic valve replacement (AVR). The contemporary use of TAVR and SAVR in patients aged 50-64 years was evaluated. In-hospital outcomes of TAVR vs SAVR were compared using propensity score matching. Readmissions were compared using the Cox proportional hazards regression model. Results Of 75,413 weighted hospitalizations for isolated AVR in patients aged 50-64 years, 22,695 (30.1%) included TAVR, and 52,718 (69.9%) included SAVR. From 2016Q1 to 2021Q4, the proportion of AVR performed using TAVR increased from 12.6% to 41.4% in patients aged 50-64 years (ptrend < .001). TAVR, compared with SAVR, was associated with lower in-hospital mortality (1.0% vs 2.0%; P < .001), stroke (1.4% vs 2.8%; P < .001), acute kidney injury (9.8% vs 17.4%; P < .001), and major bleeding (1.0% vs 1.4%, P = .04) and with higher permanent pacemaker placement (4.7% vs 3.4%; P < .001), vascular complications (3.5% vs 1.6%; P < .001), and 180-day all-cause readmissions (14.4% vs 9.0%; P < .001). Length of stay was shorter (2 vs 6 days; P < .001) and nonhome discharges were lower (17.1% vs 54.6%; P < .001) with TAVR than those with SAVR. Conclusions This nationwide observational analysis found that TAVR is increasingly performed among patients aged 50-64 years with lower in-hospital mortality and resource utilization but higher readmissions than SAVR.
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Ismayl et al. (2025) conducted an observational in Isolated aortic valve replacement (n=75,413). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on In-hospital mortality (p=<0.001). TAVR was associated with lower in-hospital mortality (1.0% vs 2.0%; P<0.001) but higher 180-day readmissions (14.4% vs 9.0%; P<0.001) compared to SAVR in patients aged 50-64 years.
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