Between 2012 and 2019, TAVR volume increased significantly and was associated with an annual reduction in the adjusted odds of 1-year mortality (OR 0.93; 95% CI 0.92-0.94).
Observational
Yes
The advent of TAVR has led to a 60% increase in overall aortic valve replacements among older adults in the US, accompanied by improved 1-year survival and higher rates of home discharge.
Odds Ratio: 0.93 (95% CI 0.92–0.94)
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.
“It is time that cardiologists and cardiac surgeons, and their respective professional societies, link the existing STS Adult Cardiac Surgery database and the Transcatheter Valve Therapies Registry, along with administrative claims data. Such a resource would facilitate needed pragmatic, prospective studies and retrospective research to answer pressing implementation and health policy questions specific to this new, mature phase of AVR care in the United States.”
Mori et al. (Mon,) conducted a observational in Aortic valve replacement. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 1-year mortality (OR 0.93, 95% CI 0.92-0.94). Between 2012 and 2019, TAVR volume increased significantly and was associated with an annual reduction in the adjusted odds of 1-year mortality (OR 0.93; 95% CI 0.92-0.94).