Demographic and Hospital Drivers of Transcatheter Versus Surgical Aortic Valve Replacement in Patients Under 65: A Population Based Analysis of the United States
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0124
Submission Type:
Abstract Submission
Authors:
Sean Nguyen (1), Koray Potel (1), Emma Schaffer (2), Brett Norling (1), Rochus Voeller (3), Stephen Huddleston (4), Andrew Shaffer (2), Rosemary Kelly (1), Ranjit John (2)
Institutions:
(1) University of Minnesota, Minneapolis, MN, (2) University of Minnesota Medical Center, Minneapolis, MN, (3) University of Minnesota Medical School, Minneapolis, MN, (4) University of Minnesota Medical School, Saint Paul, MN
Submitting Author:
Sean Nguyen
-
Contact Me
University of Minnesota
University of Minnesota
Co-Author(s):
Koray Potel
-
Contact Me
University of Minnesota
University of Minnesota
Emma Schaffer
-
Contact Me
University of Minnesota Medical Center
University of Minnesota Medical Center
Brett Norling
-
Contact Me
University of Minnesota
University of Minnesota
♦Rochus Voeller
-
Contact Me
University of Minnesota Medical School
University of Minnesota Medical School
Stephen Huddleston
-
Contact Me
University of Minnesota Medical School
University of Minnesota Medical School
Andrew Shaffer
-
Contact Me
University of Minnesota Medical Center
University of Minnesota Medical Center
*Rosemary Kelly
-
Contact Me
University of Minnesota
University of Minnesota
*Ranjit John
-
Contact Me
University of Minnesota Medical Center
University of Minnesota Medical Center
Presenting Author:
Sean Nguyen
-
Contact Me
University of Minnesota
University of Minnesota
Abstract:
Objective: The 2020 ACC/AHA guidelines on valvular heart disease resulted in class 1A recommendations for surgical aortic valve replacement (SAVR) for patients with aortic stenosis under 65 or with life expectancy over 20 years. Despite this, transcatheter aortic valve replacement (TAVR) use continues to rise. Limited data exist on what factors influence the use of TAVR over SAVR in this younger population. We examined national trends, predictors, and utilization of TAVR versus SAVR among patients under 65.
Methods: The National Inpatient Sample (2016–2022) was queried for patients aged 20 to 65 undergoing TAVR or SAVR for primary diagnosis of aortic stenosis. Descriptive statistics were used to compare cohort demographics (age, sex, race, location, income, and payer status); hospital characteristics (control, teaching status, region, and bed size); comorbidity index; and utilization (total cost and length of stay) . Multivariable logistic regression identified independent predictors of TAVR or SAVR, adjusting for demographics, hospital characteristics, and comorbidities.
Results: A weighted total of 74,720 patients underwent TAVR or SAVR, with 52,145 (69.8%) receiving SAVR. TAVR volume rose from 1,330 procedures in 2016 to 4,420 in 2022 (+232% increase), while SAVR declined from 9,120 to 6,720 (−26% decrease). Compared to TAVR, SAVR patients were younger (median 55 [IQR 50–60] vs. 62 [59–64] years, P<0.001) and more likely male (68.4% vs. 61.5%, P<0.001). SAVR was less commonly performed at urban teaching (86.3% vs. 89.6%, P<0.001) and large hospitals (66.6% vs. 72.5%, P<0.001). No regional differences were observed. Despite longer median length of stay in SAVR patients (5 [IQR 4–7] vs. 2 [1–3] days, P<0.001), costs were similar ($45,737 [36,217–59,668] vs. $44,217 [34,524–58,342], P=0.265). On multivariable analysis, TAVR was independently associated with older age, female sex, Black race, larger hospitals, urban teaching centers, higher comorbidity index, and later year of procedure. SAVR was associated with private insurance, Hispanic or Asian/Pacific Islander race, and rural hospitals.
Conclusions: Among patients under 65, TAVR utilization is increasing while SAVR is declining. While SAVR is associated with longer hospitalization, total costs are comparable. Utilization may be influenced by sociodemographic and hospital factors. Greater adherence to clinical guidelines may reduce national variability and disparities in treatment.
Methods: The National Inpatient Sample (2016–2022) was queried for patients aged 20 to 65 undergoing TAVR or SAVR for primary diagnosis of aortic stenosis. Descriptive statistics were used to compare cohort demographics (age, sex, race, location, income, and payer status); hospital characteristics (control, teaching status, region, and bed size); comorbidity index; and utilization (total cost and length of stay) . Multivariable logistic regression identified independent predictors of TAVR or SAVR, adjusting for demographics, hospital characteristics, and comorbidities.
Results: A weighted total of 74,720 patients underwent TAVR or SAVR, with 52,145 (69.8%) receiving SAVR. TAVR volume rose from 1,330 procedures in 2016 to 4,420 in 2022 (+232% increase), while SAVR declined from 9,120 to 6,720 (−26% decrease). Compared to TAVR, SAVR patients were younger (median 55 [IQR 50–60] vs. 62 [59–64] years, P<0.001) and more likely male (68.4% vs. 61.5%, P<0.001). SAVR was less commonly performed at urban teaching (86.3% vs. 89.6%, P<0.001) and large hospitals (66.6% vs. 72.5%, P<0.001). No regional differences were observed. Despite longer median length of stay in SAVR patients (5 [IQR 4–7] vs. 2 [1–3] days, P<0.001), costs were similar ($45,737 [36,217–59,668] vs. $44,217 [34,524–58,342], P=0.265). On multivariable analysis, TAVR was independently associated with older age, female sex, Black race, larger hospitals, urban teaching centers, higher comorbidity index, and later year of procedure. SAVR was associated with private insurance, Hispanic or Asian/Pacific Islander race, and rural hospitals.
Conclusions: Among patients under 65, TAVR utilization is increasing while SAVR is declining. While SAVR is associated with longer hospitalization, total costs are comparable. Utilization may be influenced by sociodemographic and hospital factors. Greater adherence to clinical guidelines may reduce national variability and disparities in treatment.
ADULT CARDIAC:
Aortic Valve
Image or Table
