Transcatheter Versus Mechanical and Bioprosthetic Surgical Aortic Valve Replacement in Retrospective Patient Cohorts with Aortic Stenosis <75 Years

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe symptomatic aortic stenosis (n=1646). Intervention: Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR). Primary outcome: Composite of all-cause death, stroke, and cardiovascular rehospitalization at 5 years post-procedure (HR 1.00, 95% CI 0.64-1.54, p=0.986).

Q: What does this research mean for the field?

In aortic stenosis patients under 75 years of age, transcatheter aortic valve replacement confers a similar 5-year risk of composite death, stroke, or cardiovascular rehospitalization compared to surgical aortic valve replacement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the 5-year clinical outcomes of patients with aortic stenosis younger than 75 years undergoing transcatheter or surgical aortic valve replacement.

X H Wang; Lijun Zeng; 欧袁伟翔; Xi Zhang; Yong Peng; Xin Wei; Wei Meng; Yuan Feng; Ole De Backer; Mao Chen

doi:10.3390/jcm15145574

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July 16, 2026Journal of Clinical MedicineOpen Access

Transcatheter Versus Mechanical and Bioprosthetic Surgical Aortic Valve Replacement in Retrospective Patient Cohorts with Aortic Stenosis <75 Years

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Why the study?

Comparisons between transcatheter and surgical aortic valve replacement in younger aortic stenosis patients are scarce.

Does transfemoral TAVR compared to SAVR improve the composite of all-cause death, stroke, and cardiovascular rehospitalization in patients under 75 years with severe symptomatic aortic stenosis?

Key Points

To evaluate the 5-year clinical outcomes of patients with aortic stenosis younger than 75 years undergoing transcatheter or surgical aortic valve replacement.
Retrospective single-center study evaluating 1646 aortic stenosis patients aged <75 years who received transfemoral TAVR (n = 808) or SAVR (n = 838) between 2014 and 2023 from a Chinese real-world database.
Median follow-up duration was 56 months (IQR: 36–83 months), with 42 months for TAVR and 76 months for SAVR.
Baseline differences were adjusted using inverse probability of treatment weighting (IPTW), multilevel regression models, and competing-risk analysis, with subgroup analyses for mechanical versus bioprosthetic SAVR and bicuspid aortic valve (BAV) anatomy.
The 5-year adjusted risk of the primary composite outcome (all-cause death, stroke, and cardiovascular rehospitalization) was similar between groups (TAVR 45.9% vs. SAVR 43.4%; weighted HR, 1.00; 95% CI, 0.64–1.54; p = 0.986).
Five-year bioprosthetic structural valve deterioration was comparable between groups overall (5.7% vs. 8.4%, p = 0.478) and in patients with BAV (7.8% vs. 13.2%, p = 0.345).
TAVR patients experienced a significantly higher 5-year weighted risk of new permanent pacemaker implantation compared to SAVR (22.7% vs. 2.6%; weighted HR, 10.66; 95% CI, 3.34–34.05; p < 0.001) and higher moderate-to-severe paravalvular leak (6.8% vs. <0.1%, p < 0.001).

Study Design

Type

Cohort (n=1,646)

Multicenter

No

Structured PICO

Does transfemoral TAVR compared to SAVR improve the composite of all-cause death, stroke, and cardiovascular rehospitalization in patients under 75 years with severe symptomatic aortic stenosis?

P

Population

1,646 patients aged 18 to 74 years with severe symptomatic aortic stenosis and low-to-intermediate surgical risk who underwent TAVR or SAVR, followed for up to 5 years.

E

Exposure

Transfemoral transcatheter aortic valve replacement (TAVR)

C

Comparator

Surgical aortic valve replacement (SAVR), including mechanical and bioprosthetic valves

O

Outcome

Composite of all-cause death, stroke, and cardiovascular rehospitalization at 5 years post-procedurecomposite

Main Result

Hazard Ratio: 1 (95% CI 0.64–1.54)

Absolute Event Rate: 45.9% vs 43.4%

p-value: p=0.986

Limitations

Retrospective, single-center design
Lack of cardiac CT measurements
Lack of independent core-laboratory assessments for valve performance
Limited subgroup sample size
Inherent historical bias due to evolving guidelines and technologies
Potential under-ascertainment and under-estimation of clinical endpoints
Inherent historical bias and unstandardized medical therapy details

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Implication

In patients under 75 years with severe aortic stenosis, TAVR demonstrated comparable 5-year risk-adjusted major clinical outcomes to SAVR, though it was associated with a significantly higher risk of new pacemaker implantation.

Abstract

Background: Comparisons between transcatheter and surgical aortic valve replacement (TAVR or SAVR) in younger aortic stenosis (AS) patients are scarce. The aim of the study was to evaluate the 5-year outcomes of AS patients <75 years undergoing TAVR or SAVR. Methods: This was a single-center study that retrospectively included AS patients <75 years who underwent transfemoral TAVR or SAVR from a Chinese real-world database (2014–2023). The primary outcome was defined as the composite of all-cause death, stroke, and cardiovascular rehospitalization at 5 years post-procedure. Robust risk adjustment was performed using inverse probability weighting (IPTW), multilevel regression models, and competing-risk analysis. Sensitivity analyses included comparison between TAVR and mechanical or bioprosthetic SAVR separately in the overall cohort and patients with bicuspid aortic valve (BAV). Results: A total of 1646 patients undergoing TAVR (n = 808) or SAVR (n = 838) were finally included. At baseline, TAVR patients had an older age [(67.9 ± 5.2) vs. (56.5 ± 9.6) years, p < 0.001] and a higher surgical risk score [(3.1 ± 1.5) vs. (2.1 ± 1.0) %, p < 0.001] than SAVR patients, which was well balanced after IPTW. The 5-year adjusted risk of the primary outcome was similar (TAVR 45.9% vs. SAVR 43.4%, weighted hazard ratio, 1.00, 95% confidence interval, 0.64–1.54, p = 0.986), which stayed comparable between TAVR and mechanical or bioprosthetic SAVR separately. In BAV patients (n = 516), the risk of death was 8.3% in the TAVR group and 3.4% in the SAVR group (p = 0.349). The risk of bioprosthetic structural valve deterioration at 5 years was comparable between groups in the overall cohort (5.7% vs. 8.4%, p = 0.478) and BAV patients (7.8% vs. 13.2%, p = 0.345). Conclusions: In this retrospective study of patients aged <75 years, the risk-adjusted 5-year major clinical outcomes were statistically similar between TAVR and SAVR. However, given the inherent historical imbalances, these exploratory findings should be interpreted with caution, and dedicated prospective studies are still needed in younger and BAV populations.

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Cite This Study

Wang et al. (2026) conducted a cohort in Severe symptomatic aortic stenosis (n=1,646). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Composite of all-cause death, stroke, and cardiovascular rehospitalization at 5 years post-procedure (HR 1.00, 95% CI 0.64-1.54, p=0.986).

synapsesocial.com/papers/6a5b18b318557b26c203a7f6 https://doi.org/10.3390/jcm15145574

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Transcatheter Versus Mechanical and Bioprosthetic Surgical Aortic Valve Replacement in Retrospective Patient Cohorts with Aortic Stenosis <75 Years

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transcatheter Versus Mechanical and Bioprosthetic Surgical Aortic Valve Replacement in Retrospective Patient Cohorts with Aortic Stenosis <75 Years

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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