TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT IN ELDERLY PATIENTS: A PROPENSITY SCORE MATCHED ANALYSIS FROM THE NATIONAL READMISSION DATABASE 2011-2015
Lemor A, Villablanca P, Hernandez G, Frisoli T, Wang DD, Eng MH, and O'Neill WW. TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT IN ELDERLY PATIENTS: A PROPENSITY SCORE MATCHED ANALYSIS FROM THE NATIONAL READMISSION DATABASE 2011-2015. J Am Coll Cardiol 2019; 73(9):1038.
J Am Coll Cardiol
Background: Transcatheter aortic valve replacement (TAVR) has increased in numbers in the past decade and older patients tend to have a higher risk when undergoing surgical aortic valve replacement (SAVR). Methods: Using the National Readmission Database we included patients 80 years and older who underwent either TAVR or SAVR from 2011 to 2015. In-hospital outcomes of TAVR versus SAVR were compared using propensity-matched analysis to reduce the confounding effect of between-group imbalances. Results: A total of 45,639 TAVR and 273,130 SAVR were performed during the study period. The propensity score-matching algorithm yielded 19,713 patients in each group. The in-hospital mortality rates were significantly lower in TAVR compared to SAVR (3.4% vs 6.8%, p<0.001). Similarly, the 30-day readmission rate (14.7% vs 16.9% p=0.001), mean LOS (7 vs 12 days, p <0.001), and the hospital costs (US$ 60,534 vs US$ 67,426) was significantly lower for TAVR patients. In-hospital outcomes, such as acute kidney injury, vascular and cardiac complications, stroke, and transfusions were significantly lower in patients that underwent TAVR. There was a significant increase in the use of TAVR (436 in 2011 to 14,945 in 2015) and a decrease in SAVR (56,388 in 2011 to 43,673 in 2015). Conclusion: In elderly patients, TAVR was associated with significant lower mortality, readmission rates, vascular and cardiac complications, acute kidney injury, stroke, transfusions, length of stay, and hospital costs in comparison with SAVR. [Figure presented]
9 Suppl 1