{"id":"eba2370ffd2a","type":"article","url":"https://hartvaat.nl/2026/06/27/tavr-bij-patienten-65-jaar-hogere-sterfte-en-heropnames-dan-chirurgie-maar-onvol/","title":"TAVR bij patiënten ≤65 jaar: hogere sterfte en heropnames dan chirurgie, maar onvoldoende bewijs — overzicht","title_en":"Transcatheter Aortic Valve Replacement in Patients Aged 65 Years and Younger: Unresolved Issues and Future Directions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Life (Basel, Switzerland)","doi":"10.3390/life16071075","source_url":"https://doi.org/10.3390/life16071075","authors":["Julius Jelisejevas","Giacomo Maria Cioffi","Ioannis Skalidis","Serban Puricel","Ali Husain","David A Wood","Mariama Akodad","Peter Wenaweser","Pascal Meier","Mario Togni","Stéphane Cook"],"significance":5,"published":"2026-08-04","source_date":"2026-06-27","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"This narrative review examines transcatheter aortic valve replacement (TAVR) in patients aged 65 and younger, a population where guidelines still prefer surgical aortic valve replacement (SAVR). Observational data indicate higher mid-term mortality and heart failure readmissions following TAVR compared with SAVR, though these outcomes are likely confounded by the higher comorbidity burden and surgical risk in patients selected for the procedure. With no dedicated randomized trials and unresolved questions regarding valve durability and future redo interventions, the choice between TAVR and SAVR in younger patients remains highly centre-dependent and requires careful individualized assessment.","created":"2026-07-29T01:08:51Z","updated":"2026-08-10T10:37:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Dit overzicht analyseert de huidige stand van zaken rondom TAVR bij patiënten van 65 jaar en jonger, een groep waar de richtlijnen nog steeds chirurgische aortaklepvervanging (SAVR) prefereren. Observatiedata tonen een hogere sterfte en meer hartfalenheropnames na TAVR vergeleken met SAVR, hoewel deze verschillen waarschijnlijk worden beïnvloed door een zwaardere comorbiditeitslast en hogere chirurgische risico’s bij de geselecteerde TAVR-patiënten. Omdat er geen gerandomiseerde trials zijn en de langdurige klepduurzaamheid en redo-opties onzeker blijven, blijft de keuze voor TAVR in deze jongere groep een klinische afweging die sterk varieert per centrum.","abstract_original":"INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has become the predominant treatment for severe aortic stenosis across all surgical risk categories. However, its role in patients aged 65 years and younger remains uncertain, and current guideline recommendations continue to favor surgical aortic valve replacement (SAVR) in this population. Despite this, contemporary real-world data demonstrate a marked increase in TAVR utilization among younger patients, creating an important gap between guidelines and clinical practice. METHODS: This review synthesizes contemporary observational evidence evaluating TAVR in patients ≤65 years, with a focus on patient selection, clinical outcomes, and lifetime management considerations. RESULTS: Available studies demonstrate that younger patients undergoing TAVR often represent a highly selected and clinically complex population with greater comorbidity burden, higher surgical risk, and shorter life expectancy than age-matched SAVR recipients, yet substantial hospital-level variation in TAVR utilization exists even after risk adjustment. Mid-term observational data suggest higher mortality and heart failure readmission rates following TAVR compared with SAVR, although these findings are likely influenced by substantial baseline differences between treatment groups. No randomized controlled trial has specifically compared TAVR and SAVR in patients ≤65 years. Furthermore, long-term issues including valve durability, coronary access, redo-TAVR feasibility, and THV optimization remain incompletely understood. CONCLUSIONS: TAVR recipients ≤65 are often a clinically distinct group characterized by significantly heavier comorbidity burdens than SAVR recipients of the same age with standard surgical risk models possibly underestimating the true clinical risk. Despite this, significant hospital-level variation in TAVR utilization persists even after risk adjustment, suggesting that institutional practice patterns and other non-clinical factors continue to influence treatment selection."}