麻豆传媒

Even before transcatheter aortic valve replacement (TAVR) was first approved in the U.S. for intermediate-risk patients in 2016, it was becoming more and more popular among younger individuals that need a new aortic valve, researchers found.

The absolute number of TAVRs increased from 1,531 in 2012 to 5,567 in 2015 in the National Inpatient Sample (NIS), with the proportion of TAVRs among all AVRs increasing among all age groups over time as well, according to a group led by Art Sedrakyan, MD, PhD, of Weill Cornell Medicine in New York City.

Notably, a growing minority of AVR recipients age 55 years and under got TAVR, up from 1.2% in 2012 to 3.5% in 2015, with the rest getting surgical replacement (SAVR), Sedrakyan and colleagues reported online in . Similarly, the 56 to 65 age group receiving TAVR went from 2.5% of all AVRs in 2012 to 7.3% in 2015.

Older patients were still most likely to get the transcatheter procedure for their AVR (10.0% of those age 66-75 years and 36.8% of those 76 years and older). The distribution of patients by age in the TAVR cohort didn't change over time.

Out of more than 70,000 AVRs in 2012-2015, 19.0% were transcatheter and the rest surgical in the NIS, which is a 20% stratified sample of all inpatient discharges from non-federal hospitals in the U.S.

Fewer of the TAVR recipients under 55 years of age were women compared with TAVR recipients age 76 and older (30.9% versus 48.7%, P<0.001).

"Data from the NIS are only available through 2015 and current use of TAVR in 2018 has likely increased further," the authors noted. The NIS also doesn't track previous AVRs or coronary artery bypass grafting. Prior cardiac surgery may explain, in some cases, why younger patients are getting TAVR despite concerns about the durability of bioprosthetic valves implanted using this method.

"Patients 65 years and younger should be informed of the limited evidence for long-term outcomes with TAVR compared with SAVR in this age group. Registries and future trials should collect longer-term follow-up data for these patients," Sedrakyan's group urged.

Centers for Medicare and Medicaid Services (CMS) is reviewing the current evidence on TAVR as part of its process to update the National Coverage Determination for the procedure (set for release by June 25, 2019). This came about in response to requests for CMS coverage to be based on quality outcomes instead of volume.

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