OR7-4 | Comparative Analysis of TAVR versus SAVR in patients with Heart Failure with Reduced Ejection Fraction: A Nationwide Observational Study

The optimal choice between transcatheter (TAVR) versus surgical (SAVR) aortic valve replacement in patients with heart failure with reduced ejection fraction (HFrEF) remains subject to shared decision-making, primarily due to a lack of comprehensive investigation by large-scale studies and trials. A retrospective cohort study was undertaken, utilizing data from the National Inpatient Sample database (2016-2022). Patient cohorts with concomitant severe aortic stenosis and HFrEF undergoing aortic valve replacement were identified and categorized based on the chosen surgical or interventional approach. Outcomes, encompassing mortality and in-hospital complications, were subjected to analysis using multivariate logistic regression. 96, 634 patients were identified with concomitant severe aortic stenosis and HFrEF; among these 76% underwent an interventional replacement. Compared to the SAVR cohort, the TAVR group was older (mean age was 78 vs 68 year-old, p<0. 001), with more females (31% vs 23%, p<0. 001), and encompassed more Medicare patients (89% vs 67%). After adjusting for confounders, TAVR demonstrated an 80% reduction in in-hospital mortality compared to the SAVR intervention (Adjusted Odds Ratio (aOR): 0. 20; 95% Confidence Interval (CI): 0. 08-0. 47; p-value < 0. 001). The interventional approach was also associated with a 6-day shorter length of stay 95% CI: - (6. 7-5. 7), p < 0. 001 and led to a 34, 686 lower total hospital charge 95% CI: - (49, 086-20, 286), p < 0. 001. As far as complications, TAVR resulted in lower risk of cardiogenic shock (aOR: 0. 11, CI: 0. 06-0. 20; p-value<0. 001), intra-aortic balloon pump use (aOR: 0. 07, CI: 0. 03-0. 18; p-value<0. 001), vascular complication (aOR: 0. 44, CI: 0. 24-0. 83; p-value=0. 012), blood transfusion (aOR: 0. 10, CI: 0. 07-0. 15; p-value<0. 001), acute respiratory failure (aOR: 0. 30, CI: 0. 09-0. 97; p-value=0. 046), mechanical ventilation use (aOR: 0. 19, CI: 0. 11-0. 32; p-value<0. 001), and acute ischemic stroke (aOR: 0. 47, CI: 0. 24-0. 93; p-value=0. 031). In this comprehensive nationwide observational analysis, TAVR emerges as the preferred choice, demonstrating an enhanced safety profile and improved survival compared to SAVR.