Key result
Transcatheter aortic valve replacement was associated with significant annual improvement in 30-day postoperative mortality (annual adjusted HR 0.84; 95% CI 0.80-0.88), reaching 2.37% in 2018.
Why the study?
Population-based utilization trends and outcomes of transcatheter aortic valve replacement and surgical aortic valve replacement remained unknown.
Does transcatheter aortic valve replacement improve 30-day postoperative mortality compared to surgical aortic valve replacement in patients undergoing aortic valve replacement?
Cohort (n=37,566)
Yes
Does transcatheter aortic valve replacement improve 30-day postoperative mortality compared to surgical aortic valve replacement in patients undergoing aortic valve replacement?
Absolute Event Rate: 2.37% vs 0.97%
Between 2011 and 2018 in New York, TAVR utilization grew massively and overtook SAVR, accompanied by continuous and significant improvements in 30-day postoperative mortality for TAVR.
TAVR 30-day mortality declined over time in this cohort; leaves open whether contemporary TAVR now outperforms SAVR.
BACKGROUND: Population-based utilization trends and outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) remain unknown. OBJECTIVES: To examine the utilization trends and outcomes of TAVR and SAVR in New York using all-inclusive aggregated statewide cardiac registries. METHODS: We described the utilization trends, compared baseline characteristics, and evaluated short-term outcomes of TAVR vs SAVR during 2011-2018 in New York. We applied Cox proportional hazards models to analyze changes in 30-day postoperative mortality for TAVR and SAVR. RESULTS: Of a total 37,566 aortic valve replacement (AVR) patients, 50.8% underwent TAVR and 49.2% received SAVR. TAVR's annual volume increased from 715 in 2012 to 4849 in 2018 (578.18% increase) whereas SAVR's annual volume decreased from 2619 in 2012 to 1855 in 2018 (29.17% decrease). TAVR patients were older, more likely to be female and white, and less likely to be Hispanic. Younger patients (<65 years) and Medicare managed-care patients received TAVR (vs SAVR) a lower percentage of the time relative to older patients (≥65 years) and Medicare fee-for-service patients, respectively. In 2018, the unadjusted 30-day mortality rate was 2.37% for TAVR whereas the rate was 0.97% for SAVR. There was significant annual improvement in 30-day mortality for TAVR (annual adjusted hazard ratio, 0.84, 95% confidence interval, 0.80-0.88) but not for SAVR (annual adjusted hazard ratio, 0.96; 95% confidence interval, 0.91-1.01). CONCLUSION: TAVR and AVR experienced massive growth whereas SAVR decreased in New York. Younger and Medicare managed-care patients had unique utilization trends. TAVR was associated with continuous improvement in 30-day postoperative mortality.
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Qian et al. (2022) conducted a cohort in Aortic valve replacement (n=37,566). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day postoperative mortality (2018 unadjusted rate). Transcatheter aortic valve replacement was associated with significant annual improvement in 30-day postoperative mortality (annual adjusted HR 0.84; 95% CI 0.80-0.88), reaching 2.37% in 2018.
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