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. 2020 Dec;95(12):2655-2664.
doi: 10.1016/j.mayocp.2020.07.030.

Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency

Anas A Alharbi  1 , Muhammad Z Khan  2 , Mohammed Osman  3 , Muhammad U Khan  2 , Muhammad B Munir  4 , Moinuddin Syed  3 , Safi U Khan  2 , Sudarshan Balla  3
Affiliations

Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency

Anas A Alharbi et al. Mayo Clin Proc. 2020 Dec.

Abstract

Objective: To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI).

Background: The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.

Patients and methods: We analyzed the National Inpatient Sample database from January 1, 2016, to December 31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR. Patients with concomitant aortic stenosis, or history of infective endocarditis, and those below the age of 18 years were excluded.

Results: A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P <.001). There was no evidence of a difference in in-hospital mortality between the 2 groups. However, after adjustment, patients in the TAVR group were associated with favorable outcomes in terms of acute kidney injury, cardiogenic shock, postoperative respiratory complications, and length of stay. On the other hand, those in the SAVR group were less likely to need permanent pacemakers.

Conclusion: There was no evidence of a significant statistical difference in in-hospital mortality between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched cohorts. TAVR could be considered for patients with PAI who are not candidates for surgery.

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Conflict of interest statement

Potential Competing Interests: The authors report no competing interests.

Figures

FIGURE 1.
FIGURE 1.
Flow sheet of the patient selection process from the NIS database. NIS = national inpatient sample; SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement.
FIGURE 2.
FIGURE 2.
Number of TAVR and SAVR in 2016 and 2017. SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement.
FIGURE 3.
FIGURE 3.
Length of hospital stay in TAVR and SAVR groups in days. SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement.
FIGURE 4.
FIGURE 4.
Cost of hospitalization in TAVR and SAVR groups in US dollars. SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement.
See this image and copyright information in PMC

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