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. 2023 Nov 14;82(20):1889-1902.
doi: 10.1016/j.jacc.2023.08.044. Epub 2023 Oct 23.

Association of Age and Sex With Use of Transcatheter Aortic Valve Replacement in France

Graeme Prosperi-Porta  1 , Virginia Nguyen  2 , Nadav Willner  1 , Julien Dreyfus  2 , Helene Eltchaninoff  3 , Ian G Burwash  1 , Morgane Michel  4 , Eric Durand  3 , Martine Gilard  5 , Christel Dindorf  6 , Bernard Iung  7 , Alain Cribier  3 , Alec Vahanian  8 , Karine Chevreul  9 , David Messika-Zeitoun  10
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Free article

Association of Age and Sex With Use of Transcatheter Aortic Valve Replacement in France

Graeme Prosperi-Porta et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Current guidelines recommend selecting surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) based on age, comorbidities, and surgical risk. Nevertheless, reports from the United States suggest a rapid expansion of TAVR in young patients.

Objectives: The authors sought to evaluate the trends in TAVR uptake at a nationwide level in France according to age and sex.

Methods: Using a nationwide administrative database, we evaluated age- and sex-related trends in TAVR uptake, patient demographics, and in-hospital outcomes between 2015 and 2020.

Results: A total of 107,397 patients (44.0% female) underwent an isolated aortic valve replacement (AVR) (59.1% TAVR, 40.9% SAVR). In patients <65 years of age, the proportion of TAVR increased by 63.2% (P < 0.001) from 2015 to 2020 but remained uncommon at 11.1% of all AVR by 2020 (12.4% in females, 10.6% in males) while TAVR was the dominant modality in patients ≥65 years of age. In patients undergoing TAVR, the Charlson comorbidity index (CCI) (P = 0.119 for trend) and in-hospital mortality (P = 0.740 for trend) remained unchanged in patients <65 years of age but declined in those ≥65 years of age irrespective of sex (all P < 0.001 for trends). Females were older (P < 0.001), had lower CCI (P < 0.001), were more likely to undergo TAVR (P < 0.001), and experienced higher in-hospital mortality (TAVR, P = 0.015; SAVR, P < 0.001) that persisted despite adjustment for age and CCI.

Conclusions: In France, the use of TAVR remained uncommon in young patients, predominantly restricted to those at high risk. Important sex differences were observed in patent demographics, selection of AVR modality, and patient outcomes. Additional research evaluating the long-term impact of TAVR use in young patients and prospective data evaluating sex differences in AVR modality selection and outcomes are needed.

Keywords: age; aortic stenosis; aortic valve replacement; sex.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Willner has received support salary from the University of Ottawa Heart Institute. Dr Dreyfus has received consulting fees from Abbott. Dr Eltchaninoff serves as a proctor for and has received lecture fees from Edwards Lifesciences. Drs Eltchaninoff, Durand, Iung, and Messika-Zeitoun have received a grant from the French Government, managed by the National Research Agency (ANR) under the program “Investissements d’avenir” with the reference ANR-16-RHUS-0003. Drs Eltchaninoff and Durand were supported by a grant from the GCS G4 (FHU CARNAVAL). Dr Durand has received lecture fees from Edwards Lifesciences. Dr Cribier is on the Scientific Advisory Board of Meril Lifesciences and Cardiawave. Dr Vahanian has received lecture fees from Edwards Lifesciences; and is a consultant for Venus Medtech. Dr Messika-Zeitoun has received research grants from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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