Prognostic factors and outcomes in patients under 75 years old receiving transcatheter aortic valve implantation: insights from the LAPLACE registry

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Abstract Background Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. However, from the perspective of prosthetic valve durability, surgical aortic valve replacement (SAVR) is often prioritized in younger patients. The ESC/EACTS Guidelines for the management of valvular heart disease recommend TAVI primarily for patients aged 75 years and above. Consequently, real-world data on the characteristics and prognostic factors of TAVI patients under 75 years are limited. Purpose This study aims to compare the outcomes of TAVI patients under 75 years and those aged 75 years and above, and to estimate the prognostic factors for these outcomes. Methods A multicenter registry analysis was conducted involving 4,921 TAVI patients, of whom 73 patients were under 75 years. A 1:1 propensity score matching was performed, adjusting for key variables such as sex, body surface area, Society of Thoracic Surgeons (STS) score, albumin level, hemoglobin level, and creatinine level. The primary endpoint was a composite of mortality and heart failure rehospitalization within five years post-procedure, analyzed using survival analysis. Additionally, Cox proportional hazards modeling was used to estimate prognostic factors in the under-75 years group. Results In the matched cohort, 70 patients under 75 years and 70 patients aged 75 years and above underwent 1:1 propensity score matching. No significant difference was observed between the two groups in the composite endpoint of mortality and heart failure rehospitalization within five years (probability of being free from the composite endpoint: 77.1% vs. 74.3%, p=0.73) (Figure). In the group under 75 years, the STS score (hazard ratio (HR) [confidence interval (CI)]: 1.09 [1.03-1.15], p < 0.01), hemoglobin levels (HR [CI]: 0.63 [0.46-0.86], p < 0.01), and albumin levels (HR [CI]: 0.42 [0.17-1.04], p = 0.06; borderline significant) were identified as known prognostic factors for TAVI outcomes. Additionally, valve type (Self-expanding valves compared to balloon-expandable valves, HR [CI]: 1.53 [1.12-2.09], p < 0.01) also showed significant association. Notably, the significance of valve type persisted even after adjusting for these covariates such as STS, hemoglobin, albumin (Self-expanding valves compared to balloon-expandable valves, HR [CI]: 1.57 [1.07-2.31], p = 0.02), suggesting that valve type is an independent predictor of prognosis in TAVI patients under 75 years. Conclusion The composite endpoint of mortality and heart failure rehospitalization within five years post-TAVI was similar between patients under 75 years and those aged 75 years and above. In patients under 75 years, the type of valve used, in addition to well-known risk factors, was found to be important. Further investigation is needed to understand the long-term clinical implications of these findings.

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