OR7-5 | Outcomes and Trends of Balloon Aortic Valvuloplasty (BAV) versus Transcatheter Aortic Valve Replacement (TAVR) in Elderly Patients with Cardiogenic Shock

Small observational studies suggest that TAVR may be a more viable option in elderly patients compared to BAV in severe aortic stenosis (AS) and cardiogenic shock (CS). We sought to investigate the in-hospital outcomes of these interventions. This is a retrospective study using the National Inpatient Sample (NIS) for hospitalizations between 2017 - 2019. Patients over 80 with CS and severe AS were identified and divided into those undergoing TAVR or BAV. Outcomes of interest were mortality and in-hospital complications. Multivariate logistic analysis was used to adjust for age, gender, race, location, and relevant co-morbidities with a p-value <0.2 in univariate screen. In patients over 80 with CS and severe AS, 179,105 underwent TAVR and 18,990 BAV. Mortality of 26.8% in TAVR and 43.1% in BAV. TAVR mortality OR 0.49 (0.29 - 0.57) and in BAV OR 0.88 (0.61 - 1.27). Post-TAVR complete heart block OR 3.43 (2.54 - 4.62) and in BAV OR 2.08 (1.34 - 3.22). Pacemaker implantation in TAVR OR 3.82 (2.63 - 5.58) and in BAV OR 2.08 (1.34 - 3.22). Post-TAVR bleeding OR 4.58 (3.06 - 6.86) and in BAV OR 3.32 (1.86 - 5.93). CVA event after TAVR OR 1.54 (0.88 - 2.68) and in BAV OR 1.03 (0.45 - 2.32). Both TAVR and BAV is associated with high mortality in CS and severe AS in the elderly. TAVR is associated with reduced odds of mortality but higher odds of complete heart block requiring pacing, CVA, and bleeding compared with outcomes after BAV. Future observational studies may help clarify these associations.