AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Durability-Related and Long-Term Clinical Outcomes After Transcatheter Aortic Valve Replacement in Younger versus Older Recipients: A Propensity-Matched Analysis from a Global Federated Health Network
By Muhammad A, Munir L, Qureshi AA et al.
Introduction: Transcatheter aortic valve replacement (TAVR) has expanded from a therapy for inoperable elderly patients to a first-line option across the surgical-risk spectrum, including younger recipients. As recipients become younger, long-term valve durability assumes increasing importance, yet real world comparative data on durability-related outcomes by age remain limited. Hypothesis: We hypothesized that relatively younger (<75 years) TAVR recipients would have a higher incidence of durability-related events than older (≥75 years) recipients after adjustment for comorbidity. Methods: We performed a retrospective, propensity-matched cohort study within the TriNetX Research network (110 healthcare organizations). Adults with nonrheumatic aortic stenosis within one year before an index TAVR were eligible; patients with prior surgical aortic valve replacement (SAVR), prior cardiac or vascular prosthetic implants, or endocarditis were excluded. Cohorts defined by age at index TAVR (<75 vs ≥75 years) were matched 1:1 on sexand six comorbidities, yielding 1,380 patients per group. Outcomes, repeat TAVR, SAVR after index TAVR, coded prosthetic valve dysfunction, prosthetic valve endocarditis, and all-cause mortality, were assessed from one day after the index procedure. Risk ratios (RR) and Kaplan-Meier hazard ratios (HR) are reported as ≥75 versus <75. Results: After matching, sex and all six comorbidities were well balanced (all standardized mean differences <0.01). Younger recipients had a higher incidence of coded prosthetic valve dysfunction than older recipients (12.0% vs 8.6%; RR 0.711, 95% CI 0.568 0.889; HR 0.581, 95% CI 0.458-0.737; log-rank p<0.001). Older recipients had higher all-cause mortality (24.7% vs 16.6%; RR 1.489, 95% CI 1.282-1.730; p<0.001). Repeat TAVR (1.4% vs 1.7%; RR 0.870, 95% CI 0.480-1.576) and prosthetic valve endocarditis (5.2% vs 3.9%; RR 1.333, 95% CI 0.944-1.882) did not differ significantly. No SAVR after index TAVR was captured in either cohort. Conclusions: In a propensity-matched real-world cohort, younger (<75 years) TAVR recipients had a higher incidence of coded prosthetic valve dysfunction, whereas older (≥75 years) recipients had higher all-cause mortality, consistent with greater competing mortality in the oldergroup. These findings support continued durability surveillance and lifetime valve management planning as TAVR extends to longer-lived patients.