Temporal Trends in Utilization and Early Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients Younger Than 70 Years

Background Transcatheter aortic valve replacement (TAVR) has expanded across surgical-risk categories; utilization among younger patients remains insufficiently characterized. We evaluated temporal trends in TAVR and surgical aortic valve replacement (SAVR) utilization and clinical outcomes among patients younger than 70 years. Methods This retrospective multicenter study included TAVR and SAVR procedures in patients <70 years (2014–2024). Baseline characteristics and outcomes were compared between procedures. All comparisons were unadjusted. Utilization and outcomes were analyzed temporally and by age (<50, 50–59, 60–69 years); TAVR surgical-risk profiles were analyzed temporally. Outcomes were in-hospital acute kidney injury (AKI), stroke, bleeding, and 30-day mortality. Results Among 5,755 procedures (1,008 TAVR; 4,747 SAVR), TAVR volume increased from 15 in 2014 to 134 in 2024 (P = .002), driven by the 60–69-year group. SAVR predominated in all age groups without a significant temporal trend (P = .06). TAVR surgical-risk distribution changed significantly over time (P < .001), shifting from higher- to lower-risk categories before higher-risk use increased again. AKI was lower after TAVR than SAVR at ages 50–59 (18.1% vs 30.4%; P=.008) and 60–69 years (7.0% vs 28.2%; P < .001). TAVR-associated AKI and bleeding decreased over time (P = .001 and P=.01), whereas stroke and 30-day mortality did not (P = .60 and P=.64). Conclusions TAVR utilization increased significantly among patients aged <70 years and expanded into lower-risk groups, while SAVR remained predominant. Unadjusted outcome comparisons were descriptive and do not establish comparative effectiveness.