Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct;32(10):348-355.
doi: 10.1007/s12471-024-01888-2. Epub 2024 Aug 20.

Demographics and outcomes of patients younger than 75 years undergoing aortic valve interventions in Rotterdam

Rik Adrichem  1 , A Maarten Mattace-Raso  1 , Thijmen W Hokken  1 , Mark M P van den Dorpel  1 , Marjo J A G de Ronde  1 , Mattie J Lenzen  1 , Paul A Cummins  1 , Isabella Kardys  1 , Rutger-Jan Nuis  1 , Joost Daemen  1 , Jos A Bekkers  2 , Nicolas M Van Mieghem  3
Affiliations

Demographics and outcomes of patients younger than 75 years undergoing aortic valve interventions in Rotterdam

Rik Adrichem et al. Neth Heart J. 2024 Oct.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is considered a safe and effective alternative to surgical aortic valve replacement (SAVR) for elderly patients across the operative risk spectrum. In the Netherlands, TAVI is reimbursed only for patients with a high operative risk. Despite this, one fifth of TAVI patients are < 75 years of age. We aim to compare patient characteristics and outcomes of TAVI and SAVR patients < 75 years.

Methods: This study included all patients < 75 years without active endocarditis undergoing TAVI or SAVR for severe aortic stenosis, mixed aortic valve disease or degenerated aortic bioprosthesis between 2015 and 2020 at the Erasmus University Medical Centre. Dutch authority guidelines were used to classify operative risk.

Results: TAVI was performed in 292 patients, SAVR in 386 patients. Based on the Dutch risk algorithm, 59.6% of TAVI patients and 19.4% of SAVR patients were at high operative risk. There was no difference in 30-day all-cause mortality between TAVI and SAVR (2.4% vs 0.8%, p = 0.083). One-year and 5‑year mortality was higher after TAVI than after SAVR (1-year: 12.5% vs 4.3%, p < 0.001; 5‑year: 36.8% vs 12.0%, p < 0.001). Within risk categories we found no difference between treatment strategies. Independent predictors of mortality were cardiovascular comorbidities (left ventricular ejection fraction < 30%, atrial fibrillation, pulmonary hypertension) and the presence of malignancies, liver cirrhosis or immunomodulatory drug use.

Conclusion: At the Erasmus University Medical Centre, in patients < 75 years, TAVI is selected for higher-risk phenotypes and overall has higher long-term mortality than SAVR. We found no evidence for worse outcome within risk categories.

Keywords: Aortic valve disease; Risk assessment; Surgical aortic valve replacement; Survival; Transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

R. Adrichem, A. M. Mattace-Raso, T.W. Hokken, M.M.P. van den Dorpel, M.J.A.G. de Ronde, M.J. Lenzen, P.A. Cummins, I. Kardys, R.-J. Nuis, and J.A. Bekkers declare that they have no competing interests. N.M. Van Mieghem has received research grant support from Abbott Vascular, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Pulsecath BV, Abiomed and Daiichi Sankyo, and consultancy and speaker fees from Jenavalve, Daiichi Sankyo, Abbott Vascular, Boston Scientific, Medtronic, Abiomed and Amgen. J. Daemen received institutional grant/research support from Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Microport, Pie Medical and ReCor Medical, and consultancy and speaker fees from Abbott Vascular, Abiomed, ACIST Medical, Boston Scientific, Cardialysis BV, CardiacBooster, Kaminari Medical, ReCor Medical, PulseCath, Pie Medical, Sanofi, Siemens Health Care and Medtronic.

Figures

Fig. 1
Fig. 1
Infographic: Demographics and outcomes of patients < 75 years of age undergoing aortic valve interventions in Rotterdam. TAVI transcatheter aortic valve implantation, SAVR surgical aortic valve replacement, LV left ventricular, LVEF left ventricular ejection fraction, CP Child-Pugh class
Fig. 2
Fig. 2
a Distribution of risk criteria. b Distribution of risk categories. Low risk no risk criteria, Intermediate risk 1 high-risk criterion, High risk ≥ 2 high-risk criteria or ≥ 1 very high-risk criteria. c Distribution of frailty. TAVI transcatheter aortic valve implantation, SAVR surgical aortic valve replacement, LV left ventricular, LVEF left ventricular ejection fraction, CP Child-Pugh class
Fig. 3
Fig. 3
Kaplan-Meier curves of all-cause survival. TAVI transcatheter aortic valve implantation, SAVR surgical aortic valve replacement
See this image and copyright information in PMC

References

    1. Mesnier J, Panagides V, Nuche J, Rodes-Cabau J. Evolving indications of transcatheter aortic valve replacement-where are we now, and where are we going. J Clin Med. 2022;11:3090. - DOI - PMC - PubMed
    1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705. - DOI - PubMed
    1. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380:1706–15. - DOI - PubMed
    1. Daeter EJ, van Veghel D, Houterman S, Olsthoorn J, Soliman-Hamad MA, Netherlands Heart Registration Transcatheter Heart Interventions Registration. Recent trends in aortic valve interventions: data of the Netherlands heart registration. J Card Surg. 2021;36:573–81. - DOI - PubMed
    1. de Jaegere PPT, de Weger A, den Heijer P, et al. Treatment decision for transcatheter aortic valve implantation: the role of the heart team : Position statement paper of the Dutch Working Group of Transcatheter Heart Interventions. Neth Heart J. 2020;28:229–39. - DOI - PMC - PubMed

LinkOut - more resources