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Multicenter Study
. 2021 Nov 30;78(22):2161-2172.
doi: 10.1016/j.jacc.2021.09.855.

Trends in Transcatheter and Surgical Aortic Valve Replacement Among Older Adults in the United States

Makoto Mori  1 , Aakriti Gupta  2 , Yun Wang  3 , Torsten Vahl  4 , Tamim Nazif  4 , Ajay J Kirtane  4 , Isaac George  5 , Celina M Yong  6 , Oyere Onuma  7 , Susheel Kodali  4 , Arnar Geirsson  8 , Martin B Leon  4 , Harlan M Krumholz  9
Affiliations
Free article
Multicenter Study

Trends in Transcatheter and Surgical Aortic Valve Replacement Among Older Adults in the United States

Makoto Mori et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Recent trends, including survival beyond 30 days, in aortic valve replacement (AVR) following the expansion of indications for transcatheter aortic valve replacement (TAVR) are not well-understood.

Objectives: The authors sought to characterize the trends in characteristics and outcomes of patients undergoing AVR.

Methods: The authors analyzed Medicare beneficiaries who underwent TAVR and SAVR in 2012 to 2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. Cox proportional hazard models were used to assess the annual change in outcomes.

Results: Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95% CI: 0.92-0.94) for TAVR and 0.98 (95% CI: 0.97-0.99) for SAVR, and 0.94 (95% CI: 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR.

Conclusions: The advent of TAVR has led to about a 60% increase in overall AVR in older adults. Improving outcomes in AVR as a whole following the advent of TAVR with increased access is a reassuring trend.

Keywords: discharge depositions; older adults; surgical aortic valve replacement; transcatheter aortic valve replacement; trend.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Mori is a PhD student in the Investigative Medicine Program at Yale, which is supported by CTSA grant number UL1 TR001863 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Dr Gupta was supported by NIH training grant T32 HL007854. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Dr Gupta has received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to an IVC filter litigation; holds equity in Heartbeat Health, Inc; and has received consulting fees from Edwards Lifesciences. Dr Vahl has received institutional funding from Boston Scientific, Edwards Lifesciences, JenaValve, Medtronic, and Siemens Healthineers; and has personally received consulting fees from Abbott Vascular, Boston Scientific, and Siemens Healthineers. Dr Kirtane has received institutional funding from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical; has received fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting; has been a consultant for Neurotronic; and has received travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Dr Leon is an early physician founder and has an equity relationship (<1% of the company) with Mitralign. Dr Kodali has received consultant honoraria from Admedus, Dura Biotech, and TriCares; has equity in Dura Biotech, MicroInterventional Devices, Thubrikar Aortic Valve Inc, Supira, Admedus, TriFlo, and Adona; and has received institutional research funding from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. Dr. Krumholz, in the past 3 years, has received expenses and/or personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, Massachusetts Medical Society, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, Martin/Baughman Law Firm, F-Prime, and the National Center for Cardiovascular Diseases in Beijing; is a co-founder of Refactor Health and HugoHealth; and has received grants and/or contracts from the Centers for Medicare & Medicaid Services, Medtronic, U.S. Food and Drug Administration, Johnson & Johnson, Foundation for a Smoke-Free World, State of Connecticut Department of Public Health, Agency for Healthcare Research and Quality, National Institutes of Health, American Heart Association, and the Shenzhen Center for Health Information. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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