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. 2021 Sep 28;18(9):702-710.
doi: 10.11909/j.issn.1671-5411.2021.09.005.

In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

Ashraf Abugroun  1 , Osama Hallak  2 , Ahmed Taha  3 , Alejandro Sanchez-Nadales  4 , Saria Awadalla  5 , Hussein Daoud  6 , Efehi Igbinomwanhia  7 , Lloyd W Klein  8
Affiliations

In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

Ashraf Abugroun et al. J Geriatr Cardiol. .

Abstract

Objective: To compare the outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) and surgical aortic valve replacement (SAVR) using a large US population sample.

Methods: The U.S. National Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the years 2016-2017. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital stroke, pericardiocentesis, pacemaker insertion, mechanical ventilation, vascular complications, major bleeding, acute kidney injury, length of stay, and cost of hospitalization. Outcomes were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous outcomes.

Results: A total of 1560 TA-TAVR and 44,280 SAVR patients were included. Patients who underwent TA-TAVR were older and frailer. Compared to SAVR, TA-TAVR correlated with a higher mortality (4.5% vs. 2.7%, effect size (SMD) = 0.1) and higher periprocedural complications. Following multivariable analysis, both TA-TAVR and SAVR had a similar adjusted risk for in-hospital mortality. TA-TAVR correlated with lower odds of bleeding with (adjusted OR (aOR) = 0.26; 95% CI: 0.18-0.38;P < 0.001), and a shorter length of stay (adjusted mean ratio (aMR) = 0.77; 95% CI: 0.69-0.84; P < 0.001), but higher cost (aMR = 1.18; 95% CI: 1.10-1.28; P < 0.001). No significant differences in other study outcomes. In subgroup analysis, TA-TAVR in patients with chronic lung disease had higher odds for mortality (aOR = 3.11; 95%CI: 1.37-7.08; P = 0.007).

Conclusion: The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Algorithm for selection of study population.
Figure 2
Figure 2
Adjusted complication rates among TA-TAVR vs. SAVR.
See this image and copyright information in PMC

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