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July 18, 2026Open Access
View Full PaperTranscatheter Versus Mechanical and Bioprosthetic Surgical Aortic Valve Replacement in Retrospective Patient Cohorts with Aortic Stenosis <75 Years
Key Result
TAVR was associated with a similar 5-year risk of death, stroke, or cardiovascular rehospitalization compared to SAVR in patients <75 years (HR 1.00; 95% CI 0.64-1.54; p=0.986).
Key Points
- To evaluate the 5-year clinical outcomes of younger aortic stenosis patients undergoing TAVR versus SAVR.
- Retrospective single-center study of aortic stenosis patients under 75 years
- Performed transfemoral TAVR or SAVR, utilizing inverse probability weighting for risk adjustment
- Included comparisons of outcomes in overall cohort and bicuspid aortic valve patients.
- 5-year risk of primary outcome was similar between TAVR (45.9%) and SAVR (43.4%), weighted hazard ratio 1.00 (95% CI 0.64–1.54, p=0.986)
- In bicuspid aortic valve patients, 8.3% mortality in TAVR group versus 3.4% in SAVR group (p=0.349)
- Comparable risk of bioprosthetic structural valve deterioration, 5.7% for TAVR and 8.4% for SAVR (p=0.478).
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 with aortic stenosis aged <75 years?
P
Population
1,646 patients aged <75 years with aortic stenosis undergoing transfemoral TAVR or SAVR, followed for 5 years.
E
Exposure
Transfemoral transcatheter aortic valve replacement (TAVR)
C
Comparator
Surgical aortic valve replacement (SAVR), including mechanical or bioprosthetic valves
O
Outcome
Composite of all-cause death, stroke, and cardiovascular rehospitalization at 5 years post-procedurecomposite
In a retrospective cohort of patients under 75 with aortic stenosis, TAVR and SAVR demonstrated similar 5-year risk-adjusted rates of death, stroke, and cardiovascular rehospitalization.
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
- Inherent historical imbalances
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.
Trending Research#8 this week
This large retrospective study adds new 5-year outcomes data to the contentious debate over TAVR versus SAVR in younger patients, showing similar adjusted risks and fueling clinical discussion.
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Cite This Study
Wang et al. (Thu,) conducted a cohort in 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). TAVR was associated with a similar 5-year risk of death, stroke, or cardiovascular rehospitalization compared to SAVR in patients <75 years (HR 1.00; 95% CI 0.64-1.54; p=0.986).