Surgical aortic valve replacement (SAVR) was associated with better long-term survival and fewer complications than transcatheter aortic valve replacement (TAVR) in patients ages 60 and younger, according to a study published Aug. 19 in JTCVS Open.
Here are six things to know:
- Researchers analyzed 9,841 patients with aortic stenosis who underwent first-time SAVR or TAVR between January 2006 and December 2025 using the TriNetX database. After matching patients based on age, sex and several comorbidities, the analysis included 1,666 patients in each group.
- One-month mortality was comparable between the two groups. At one year, however, mortality was lower among SAVR patients compared with TAVR patients, 5.5% versus 7.7%. By five years, the gap had widened to 11.3% versus 18.3%.
- SAVR patients also had lower five-year risks of acute myocardial infarction, endocarditis, complete atrioventricular block, pacemaker implantation, paravalvular leak and reintervention compared with TAVR patients.
- Current guidelines recommend SAVR for patients younger than 65, but researchers noted that more younger patients are receiving TAVR because the procedure is less invasive, despite limited long-term data on valve durability in this population.
- The authors said mechanical aortic valves, while durable, carry a higher bleeding risk because of lifelong anticoagulation, while bioprosthetic valves avoid that requirement but face a higher risk of deterioration over time. The study did not directly evaluate that tradeoff because the database did not capture valve type.
- The findings add to recent research raising questions about TAVR outcomes in younger patients. A University of Rochester (N.Y.) Medicine study published earlier this year found nearly half of the lowest-risk patients underwent TAVR despite recommendations for SAVR, raising concerns about more complex surgeries if those valves later need to be replaced. A 2024 meta-analysis also found cardiovascular mortality was 1.66 times higher among TAVR patients with pulmonary hypertension than among those without the condition.
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