Characteristics and outcomes of patients ≤ 75 years who underwent transcatheter aortic valve implantation: insights from the SOURCE 3 Registry.

Abstract

BACKGROUND:

Current trials and registries of transcatheter valve implantation (TAVI) mostly include patients older than 75 years. Little is known about younger patients who undergo this treatment. We investigated comorbidities among patients < 75 years old who underwent TAVI in the SAPIEN 3™ European post-approval SOURCE 3 Registry, and analysed outcomes at 30 days and 1 year.

METHODS AND RESULTS:

Three age groups of patients were analysed for outcomes and characteristics: < 75 (n = 235), 75-80 (n = 391) and ≥ 80 years (n = 1320). Overall, the mean age was 81.6 ± 6.7 years; transfemoral access was used in 87.1% of patients treated with SAPIEN 3 transcatheter heart valves. The mean logistic EuroSCORE increased according to age group (12.6%, 17.3% and 19.7%, respectively, p < 0.001). Younger patients had a higher incidence of comorbidities, particularly those not included in surgical risk score assessment tools, e.g., severe liver disease, previous radiation therapy, and porcelain aorta. Mortality rates were similar between age groups at 30 days (1.7%, 2.0% and 2.3%, respectively, p = 0.79) and 1 year (14.2%, 9.3% and 13.3%, respectively, p = 0.08). However, sudden cardiac death rates were higher in the < 75 years age group compared with the ≥ 85 years age group (20.7% vs. 4.8%, p = 0.010).

CONCLUSIONS:

In current TAVI practice, patients younger than 75 years are a minority (12%). Despite younger age and lower surgical risk scores, this cohort was characterized by comorbidities not accounted for by traditional surgical risk scores. More data are needed for this age group to guide the appropriate decision between surgery and TAVI. CLINICALTRIAL.

GOV NUMBER:

NCT02698956.

• Authors: Derk Frank, Mohamed Abdel-Wahab, Martine Gilard, Franck Digne, Geraud Souteyrand, Christophe Caussin, Frédéric Collart, Vincent Letocart, Jochen Wöhrle, Christian Kuhn, Tomas Hovorka, Helmut Baumgartner
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 108 Issue 7 Pg. 763-771 (Jul 2019) ISSN: 1861-0692 [Electronic] Germany
• PMID: 30552511 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (surgery)
• Aortic Valve Stenosis (mortality, surgery)
• Cause of Death (trends)
• Europe (epidemiology)
• Female
• Humans
• Incidence
• Male
• Postoperative Complications (epidemiology)
• Registries
• Risk Assessment (methods)
• Risk Factors
• Survival Rate (trends)
• Transcatheter Aortic Valve Replacement (methods)
• Treatment Outcome