{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:59:04Z","timestamp":1785405544350,"version":"3.56.0"},"reference-count":28,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["U23A20395"],"award-info":[{"award-number":["U23A20395"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82170375"],"award-info":[{"award-number":["82170375"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"award":["U23A20395"],"award-info":[{"award-number":["U23A20395"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"award":["82170375"],"award-info":[{"award-number":["82170375"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Science and Technology Projects of the Xizang Autonomous Region, China","award":["XZ202501ZY0120"],"award-info":[{"award-number":["XZ202501ZY0120"]}]},{"name":"West China Hospital of Sichuan University","award":["ZYGD23021"],"award-info":[{"award-number":["ZYGD23021"]}]},{"name":"West China Hospital of Sichuan University","award":["23HXFH009"],"award-info":[{"award-number":["23HXFH009"]}]},{"award":["ZYGD23021"],"award-info":[{"award-number":["ZYGD23021"]}],"id":[{"id":"https:\/\/ror.org\/007mrxy13","id-type":"ROR","asserted-by":"publisher"}]},{"award":["23HXFH009"],"award-info":[{"award-number":["23HXFH009"]}],"id":[{"id":"https:\/\/ror.org\/007mrxy13","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Comparisons between transcatheter and surgical aortic valve replacement (TAVR or SAVR) in younger aortic stenosis (AS) patients are scarce. The aim of the study was to evaluate the 5-year outcomes of AS patients &lt;75 years undergoing TAVR or SAVR. Methods: This was a single-center study that retrospectively included AS patients &lt;75 years who underwent transfemoral TAVR or SAVR from a Chinese real-world database (2014\u20132023). The primary outcome was defined as the composite of all-cause death, stroke, and cardiovascular rehospitalization at 5 years post-procedure. Robust risk adjustment was performed using inverse probability weighting (IPTW), multilevel regression models, and competing-risk analysis. Sensitivity analyses included comparison between TAVR and mechanical or bioprosthetic SAVR separately in the overall cohort and patients with bicuspid aortic valve (BAV). Results: A total of 1646 patients undergoing TAVR (n = 808) or SAVR (n = 838) were finally included. At baseline, TAVR patients had an older age [(67.9 \u00b1 5.2) vs. (56.5 \u00b1 9.6) years, p &lt; 0.001] and a higher surgical risk score [(3.1 \u00b1 1.5) vs. (2.1 \u00b1 1.0) %, p &lt; 0.001] than SAVR patients, which was well balanced after IPTW. The 5-year adjusted risk of the primary outcome was similar (TAVR 45.9% vs. SAVR 43.4%, weighted hazard ratio, 1.00, 95% confidence interval, 0.64\u20131.54, p = 0.986), which stayed comparable between TAVR and mechanical or bioprosthetic SAVR separately. In BAV patients (n = 516), the risk of death was 8.3% in the TAVR group and 3.4% in the SAVR group (p = 0.349). The risk of bioprosthetic structural valve deterioration at 5 years was comparable between groups in the overall cohort (5.7% vs. 8.4%, p = 0.478) and BAV patients (7.8% vs. 13.2%, p = 0.345). Conclusions: In this retrospective study of patients aged &lt;75 years, the risk-adjusted 5-year major clinical outcomes were statistically similar between TAVR and SAVR. However, given the inherent historical imbalances, these exploratory findings should be interpreted with caution, and dedicated prospective studies are still needed in younger and BAV populations.<\/jats:p>","DOI":"10.3390\/jcm15145574","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:08:34Z","timestamp":1784189314000},"page":"5574","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcatheter Versus Mechanical and Bioprosthetic Surgical Aortic Valve Replacement in Retrospective Patient Cohorts with Aortic Stenosis &lt;75 Years"],"prefix":"10.3390","volume":"15","author":[{"given":"Xi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610044, China"},{"name":"Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-1114","authenticated-orcid":false,"given":"Lijun","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, West China Second University Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanweixiang","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610044, China"},{"name":"Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Health Care Big Data Center of Sichuan Province, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6975-8651","authenticated-orcid":false,"given":"Xin","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610044, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610044, China"},{"name":"Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole","family":"De Backer","sequence":"additional","affiliation":[{"name":"The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6008-7944","authenticated-orcid":false,"given":"Mao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610044, China"},{"name":"Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1056\/NEJMoa1008232","article-title":"Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery","volume":"363","author":"Leon","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1056\/NEJMoa1103510","article-title":"Transcatheter versus surgical aortic-valve replacement in high-risk patients","volume":"364","author":"Smith","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients","volume":"374","author":"Leon","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1056\/NEJMoa1700456","article-title":"Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients","volume":"376","author":"Reardon","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients","volume":"380","author":"Mack","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1056\/NEJMoa1816885","article-title":"Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients","volume":"380","author":"Popma","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_7","unstructured":"Writing Committee Members, Otto, C.M., Nishimura, R.A., Bonow, R.O., Carabello, B.A., Erwin, J.P., Gentile, F., Jneid, H., Krieger, E.V., and Mack, M. (2021). 2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol., 77, e25\u2013e197."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"16","author":"Praz","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"L1","DOI":"10.1093\/eurheartj\/suaa123","article-title":"Severe aortic stenosis in the young, with or without bicuspid valve: Is transcatheter aortic valve implantation the first choice?","volume":"22","author":"Belluschi","year":"2020","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1159\/000533633","article-title":"Patterns of Aortic Valve Replacement in Europe: Adoption by Age","volume":"148","author":"Rudolph","year":"2023","journal-title":"Cardiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e019588","DOI":"10.1161\/JAHA.120.019588","article-title":"Geographic and Demographic Variability in Transcatheter Aortic Valve Replacement Dispersion in the United States","volume":"10","author":"Young","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"VARC-3 Writing Committee, G\u00e9n\u00e9reux, P., Piazza, N., Alu, M.C., Nazif, T., Hahn, R.T., Pibarot, P., Bax, J.J., A Leipsic, J., and Blanke, P. (2021). Valve Academic Research Consortium 3: Updated endpoint definitions for aortic valve clinical research. Eur. Heart J., 42, 1825\u20131857.","DOI":"10.1093\/eurheartj\/ehaa799"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jtcvs.2019.02.061","article-title":"Time in therapeutic range and risk of thromboembolism and bleeding in patients with a mechanical heart valve prosthesis","volume":"159","author":"Butt","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e032949","DOI":"10.1136\/bmjopen-2019-032949","article-title":"New warfarin anticoagulation management model after heart valve surgery: Rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management model","volume":"9","author":"Zhu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1001\/jamacardio.2025.3403","article-title":"Transcatheter or Surgical Treatment of Patients with Aortic Stenosis at Low to Intermediate Risk: An Individual Participant Data Meta-Analysis","volume":"10","author":"Ludwig","year":"2025","journal-title":"JAMA Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1056\/NEJMoa2307447","article-title":"Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years","volume":"389","author":"Mack","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2714","DOI":"10.1161\/CIRCULATIONAHA.118.036606","article-title":"Five-Year Clinical and Echocardiographic Outcomes from the NOTION Randomized Clinical Trial in Patients at Lower Surgical Risk","volume":"139","author":"Thyregod","year":"2019","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.jacc.2025.03.004","article-title":"5-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis","volume":"85","author":"Forrest","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3804","DOI":"10.1093\/eurheartj\/ehae043","article-title":"Transcatheter aortic valve implantation in low-risk tricuspid or bicuspid aortic stenosis: The NOTION-2 trial","volume":"45","author":"Thyregod","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1161\/CIRCULATIONAHA.125.076678","article-title":"Three-Year Follow-Up of the NOTION-2 Trial: TAVR Versus SAVR to Treat Younger Low-Risk Patients With Tricuspid or Bicuspid Aortic Stenosis","volume":"152","author":"Savontaus","year":"2025","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jtcvs.2024.12.025","article-title":"Transcatheter versus surgical aortic valve replacement in patients younger than 65 years in the United States","volume":"170","author":"Alabbadi","year":"2025","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.athoracsur.2024.07.036","article-title":"Guidelines vs Practice: Surgical Versus Transcatheter Aortic Valve Replacement in Adults \u226460 Years","volume":"119","author":"Alabbadi","year":"2025","journal-title":"Ann. Thorac. Surg."},{"key":"ref_24","first-page":"101861","article-title":"Temporal Trends in Transcatheter Aortic Valve Replacement for Isolated Severe Aortic Stenosis","volume":"3","author":"Gupta","year":"2024","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.atssr.2025.05.008","article-title":"National Midterm Outcomes of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement","volume":"3","author":"Sohn","year":"2025","journal-title":"Ann. Thorac. Surg. Short. Rep."},{"key":"ref_26","first-page":"E1033","article-title":"Surgical versus transcatheter aortic valve replacement in low-risk patients: A long-term propensity score-matched analysis","volume":"98","author":"Madeira","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.amjcard.2025.06.024","article-title":"The cusp overlap technique reduces pacemaker implantation in TAVR\u2014A systematic review and meta-analysis","volume":"254","author":"Hazique","year":"2025","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Synetos, A., Ktenopoulos, N., Katsaros, O., Vlasopoulou, K., Drakopoulou, M., Koliastasis, L., Kachrimanidis, I., Apostolos, A., Tsalamandris, S., and Latsios, G. (2025). Paravalvular Leak in Transcatheter Aortic Valve Implantation: A Review of Current Challenges and Future Directions. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12040125"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5574\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T04:17:37Z","timestamp":1784348257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":28,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145574"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145574","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]}}}