Transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis aged 70 years or younger: A NOTION-2 substudy - 08/03/25

Doi : 10.1016/j.ahj.2025.02.003

Troels Højsgaard Jørgensen, MD, PhD ^a,^⁎ , Hans Gustav Hørsted Thyregod, MD, PhD ^a, Mikko Savontaus, MD, PhD ^b, Öjvind Bleie, MD, PhD ^c, Evald H Christiansen, MD, PhD ^d, Matti Niemela, MD, PhD ^e, Oskar Angerås, MD, PhD ^f, Ingibjörg J. Gudmundsdóttir, MD, DM ^g, Mika Laine, MD, PhD ^h, Andreas Rück, MD, PhD ⁱ, Bernard Prendergast, MD, DMSc ^j, Martin Leon, MD, PhD ^k, Lars Søndergaard, MD, DMSc ^l, Ole De Backer, MD, PhD ^a,^m
for the
NOTION-2 investigators
^a Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
^b Department of Cardiology, Turku University Hospital, Turku, Finland
^c Department of Cardiology, Haukeland University Hospital, Bergen, Norway
^d Department of Cardiology, Skejby, Aarhus University hospital, Aarhus, Denmark
^e Department of Cardiology, Oulu University Hospital, Oulu, Finland
^f Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
^g Department of Cardiology, Landspitali, Reykjavík, Iceland
^h Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
ⁱ Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
^j Department of Cardiology, St Thomas' Hospital and Cleveland Clinic London, London, UK
^k Department of Cardiology, Clinical Research Foundation and Columbia University Hospital, New York, NY
^l Abbott, Santa Clara, CA
^m Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

^⁎Reprint requests: Troels Højsgaard Jørgensen, MD, PhD, The Heart Center - Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark.The Heart Center - RigshospitaletUniversity of CopenhagenInge Lehmanns Vej 7CopenhagenDenmark

Highlights

•	Sub-analyses of low-risk patients aged ≤70 years randomized to TAVI or SAVR.
•	Patients with tricuspid native aortic valve had similar risk of primary outcome.
•	Increased risk of the primary outcome in TAVI patients with bicuspid native aortic valve.

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ABSTRACT

This NOTION-2 sub-study revealed distinct outcomes for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low surgical risk patients aged ≤ 70 years with a tricuspid or bicuspid aortic valve stenosis (AS). One year after intervention, the risk of death, stroke or rehospitalization in patients with tricuspid AS was similar after TAVR when compared to SAVR (absolute risk difference: −2.0%; 95% confidence interval (CI): −11.8% to 7.7%) Conversely, in patients with bicuspid AS, TAVR was associated with a significantly higher risk of adverse outcomes (absolute risk difference: 13.8%; 95% CI: 1.2% to 26.3%). These analyses are exploratory, but highlight the importance of tailoring the intervention to the patient's clinical risk profile, life expectancy, native aortic valve morphology and the anticipated risks associated with TAVR or SAVR.

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CRediT authorship contribution statement

Trial Registration number: ClinicalTrials.gov NCT02825134.

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Vol 284

P. 67-70 - juin 2025 Retour au numéro

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Transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis aged 70 years or younger: A NOTION-2 substudy - 08/03/25

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