Clinical outcomes after transcatheter versus surgical aortic valve replacement in patients aged 60–65 years: a single-center retrospective cohort study

Background: The rapid expansion of transcatheter aortic valve replacement (TAVR) into younger and lower-risk populations has raised concerns about its long-term durability compared to surgical aortic valve replacement (SAVR). We compared perioperative parameters, valve-related complications, reintervention rates, and survival outcomes between TAVR and SAVR in patients aged 60–65 years. Methods: We conducted a single-center retrospective cohort study of patients aged 60–65 years who underwent TAVR or SAVR between April 2017 and December 2023. Baseline characteristics, intraoperative and perioperative outcomes, and follow-up events were compared using appropriate parametric and nonparametric tests. Time-to-event outcomes were evaluated using Kaplan–Meier estimates and compared using the log-rank test. A two-sided P < 0.05 was considered statistically significant. Results: Of 2762 patients initially screened (TAVR, n = 488; SAVR, n = 2274), 110 met the inclusion criteria (TAVR, n = 48; SAVR, n = 62). The median age was 63 years (interquartile range 2), and 73.6% of patients were male. TAVR was associated with significantly shorter operative time, duration of mechanical ventilation, and hospital length of stay (all P < 0.001). However, it was associated with higher rates of permanent pacemaker implantation (12.5 vs. 0%, P = 0.006), paravalvular leak (56.3 vs. 1.6%, P < 0.001), and reintervention (12.5 vs. 1.6%, P = 0.020). At the end of follow-up, overall survival was 93.8% in the TAVR group and 96.8% in the SAVR group ( P = 0.364). Cardiac-specific survival was 93.8% in the TAVR group and 98.4% in the SAVR group ( P = 0.200). At 1-year follow-up, event-free survival (EFS) was 68.8% in the TAVR group and 85.5% in the SAVR group ( P = 0.036). At the end of follow-up, EFS was 66.7% in the TAVR group and 79.0% in the SAVR group ( P = 0.092). Conclusions: In patients aged 60–65 years, TAVR conferred clear perioperative advantages but was associated with higher rates of valve-related complications and reintervention. These findings support individualized treatment selection based on comprehensive anatomical assessment in this age group.