Aortic Valve Replacement in Young and Middle-Aged Adults: Current and Potential Roles of TAVR.

Abstract Background Contemporary practice patterns and outcomes for aortic valve replacement (AVR) among young and middle aged adults are unknown given guideline modifications for surgical AVR (SAVR) and increasing transcatheter AVR (TAVR) acceptance. We describe SAVR/TAVR use and outcomes using the Society of Thoracic Surgeons (STS) National Databases. Methods Adults 18-55 years in the Congenital Heart Surgery Database (CHSD) and the Adult Cardiac Surgery Database (ACSD) undergoing SAVR/TAVR from 2013-2018 were included. Perioperative characteristics and early outcomes were described by valve type. Multivariable regression identified determinants of death, length of hospital stay (LOS), and composite endpoint of renal failure, persistent neurological deficit, readmission, and reoperation. Results We analyzed 1,580 unique CHSD and 44,173 ACSD operations, with 16% having congenital heart disease. Valve utilization included TAVR 1%, mechanical 42%, bioprosthetic 55%, autograft 0.6%, homograft 1.2%, and Ozaki 0.4%. Over time, TAVR volumes increased by 167%. Thirty-day mortality was: TAVR 3.8%, mechanical 3.2%, bioprosthetic 3.7%, autograft 0.6%, homograft 9%, and Ozaki 3.4%. Stroke rate was lower for isolated SAVR vs. isolated TAVR (0.9% vs. 2.4%, p=0.002). In multivariable analyses, mortality risk was lower with mechanical valves, congenital morbidity risk was higher with TAVR, and LOS was shorter with TAVR. Conclusions TAVR is increasingly used for adults