Mortality and morbidity benefits of surgical versus transcatheter aortic valve replacement in patients ≤60 years: Findings from a national cohort.

OBJECTIVE: To compare outcomes of surgical aortic valve replacement (SAVR) with transcatheter aortic valve replacement (TAVR) in patients aged ≤60 years throughout the United States. METHODS: Patients aged ≤60 years with aortic stenosis undergoing either first-time SAVR or TAVR between January 2006 and December 2025 were identified from TriNetX, an administrative real-world database. The primary outcome was all-cause mortality over 5 years. Cardiac-related outcomes were also assessed. Results were analyzed after propensity matching for age, sex, presence of bicuspid aortic valve, lower respiratory disease, liver fibrosis/cirrhosis, liver failure, kidney disease, dialysis dependence, and previous cardiac surgery. RESULTS: Among 9841 patients, 7896 underwent SAVR, whereas 1945 underwent TAVR. Matching resulted in 1666 patients per cohort. Before matching, patients who underwent SAVR were younger, more likely to have bicuspid aortic valves, and had lower rates of lower respiratory disease, liver or kidney disease, dialysis use, and previous cardiac surgery. After matching, SAVR was associated with comparable mortality risk at 1 month but lower mortality risks at 1 year (odds ratio, 0.69; 95% CI, 0.53-0.92) and 5 years (hazard ratio [HR], 0.58; 95% CI, 0.48-0.69). By the end of follow-up, SAVR was associated with decreased risks of acute myocardial infarction (HR, 0.65; 95% CI, 0.49-0.86), endocarditis (HR, 0.55; 95% CI, 0.37-0.82), complete atrioventricular block (HR, 0.45; 95% CI, 0.30-0.66), pacemaker implantation (HR, 0.61; 95% CI, 0.45-0.83), paravalvular leak (HR, 0.39; 95% CI, 0.26-0.87), and reintervention (HR, 0.54; 95%, CI 0.38-0.78). CONCLUSIONS: Among patients aged ≤60 years, SAVR is associated with lower mortality and morbidity rates over TAVR.