Transcatheter Versus Surgical Aortic Valve Replacement in Patients Aged 50 to 65 Years: A Propensity Score-Matched Five-Year Study

Introduction Comparative long-term outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in younger patients remain incompletely defined, particularly beyond early follow-up. This study evaluated short-, mid-, and long-term outcomes between TAVR and SAVR in patients aged 50 to 65 years using a multicenter retrospective cohort. Methods Patients with aortic stenosis aged 50-65 years undergoing TAVR or SAVR were identified using the TriNetX database. Patients were matched 1:1 using propensity score matching (PSM). Outcomes were assessed at 30 days, 1 year, and 5 years. The primary endpoint was a composite of all-cause mortality or stroke; secondary endpoints included hospitalization, major bleeding, acute kidney injury (AKI), cardiogenic shock, and valve dysfunction. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to estimate the overall effect size. Results PSM yielded 1,041 well-balanced pairs. At 30 days, TAVR was associated with a lower risk of the primary composite endpoint (3.0% vs. 5.6%; HR 0.53; 95% CI 0.34-0.82; p=0.004), all-cause mortality (HR 0.50; p=0.03), major bleeding (HR 0.29; p<0.001), AKI (HR 0.39; p<0.001), and cardiogenic shock (HR 0.28; p<0.001). At 1 year, the composite endpoint, mortality, and stroke did not differ significantly between groups; major bleeding remained lower with TAVR (HR 0.50; p<0.001). At 5 years, TAVR was associated with higher risks of the primary composite endpoint (18.6% vs. 15.5%; HR 1.27; 95% CI 1.03-1.57; p=0.02) and all-cause mortality (13.7% vs. 8.3%; HR 1.81; 95% CI 1.39-2.37; p<0.001), while major bleeding remained lower (HR 0.65; p<0.001). Conclusion TAVR demonstrated early safety but a higher long-term risk of mortality and composite adverse outcomes at 5 years compared with SAVR.