Mortality after transcatheter aortic valve replacement in young multimorbid patients as compared to an age-, gender-and comorbidity-matched background population

Pernille Steen Bække¹Vilhelmas Bajoras^1,2,3*Jawad Butt¹Thomas Pilgrim⁴Nicholas Joseph Montarello¹Maurizio Taramasso⁵Didier Tchetche⁶Liesbeth Rosseel¹Ričardas Kundelis^2,3Kristijonas Česas³Alexander Sedaghat⁷Jan-Malte Sinning⁷Rik Adrichem⁸Mizuki Miura⁵Magdalena Erlebach⁹Stephan Windecker⁴Darren Mylotte¹⁰Raj Makkar¹¹Emil Fosbøl¹Nicolas Van Mieghem⁸Ole De Backer¹

• ¹Rigshospitalet, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
• ²Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
• ³Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
• ⁴Inselspital University Hospital Bern, Bern, Bern, Switzerland
• ⁵University Hospital Zürich, Zürich, Zürich, Switzerland
• ⁶Clinique Pasteur, Toulouse, France
• ⁷University Hospital Bonn, Bonn, Germany
• ⁸Erasmus Medical Center, Rotterdam, Netherlands
• ⁹German Heart Centre, Munich, Germany
• ¹⁰Galway University Hospital, Galway, Ireland
• ¹¹Cedars-Sinai Heart Institute, Los Angeles, United States

Introduction. Contrary to the current guidelines patients with symptomatic severe aortic stenosis and ≤65 years of age are often referred for transcatheter aortic valve replacement (TAVR). However, the outcome after TAVR in this patient cohort remains unclear.Objectives. This study aimed to assess the rationale for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred for TAVR, to evaluate 3-year all-cause mortality and to compare outcomes with a matched control cohort. Patients and methods. Retrospective data were collected on all consecutive patients ≤65 years of age with severe aortic stenosis treated with TAVR at 9 centres between 2010-2019. The TAVR-population was compared with a 1:4 age-, gender-, and comorbidity-matched population obtained from the Danish National Registries.Results. The study population consisted of 459 TAVR-recipients and 1836 matched registry-controls. The main reasons for SAVR denial were prior cardiac surgery (35%), lung disease (30%) and frailty (23%). The 3-year all-cause mortality was 34% in the TAVR-group compared with 8% in the age-, gender- and comorbidity-matched controls with a hazard ratio (HR) of 6.5 (95% CI 4.5–9.6; P<0.001). Patients undergoing TAVR with an active chronic disease (heart failure, lung disease, dialysis) had a 3-year all-cause mortality HR of 1.8 to 2.4 compared with controls. Overall, 3-year mortality rates in these distinct TAVR-subgroups were high (30-50%) irrespective of the underlying condition.Conclusions. Young, multimorbid aortic stenosis patients aged ≤65 years and treated with TAVR between 2010-2019 have increased medium-term all-cause mortality compared with an age-, gender- and comorbidity-matched background population.