Key result
Transfemoral TAVR in patients over 80 linked to ~11% lower in-hospital mortality per year.
Why the study?
While TAVR outcome trends are well described, it remained unclear how these trends vary across different age groups and to what extent they are driven by changes in procedural characteristics versus decreasing patient risk profiles.
Do evolving procedural characteristics and patient risk profiles improve in-hospital mortality and complications after transfemoral TAVR across different age groups over time?
Cohort (n=204,230)
Yes
Do evolving procedural characteristics and patient risk profiles improve in-hospital mortality and complications after transfemoral TAVR across different age groups over time?
Odds Ratio: 0.89 (95% CI 0.84–0.94)
Absolute Event Rate: 1.5% vs 5.3%
p-value: p=<0.01
TAVR outcomes have improved significantly over time across most age groups, likely driven by both decreasing patient risk profiles and improving procedural characteristics.
Declining TAVR mortality in patients >80 may reflect care advances; leaves open relative roles of selection versus technique in this observational analysis.
Background The trends in outcomes in patients who undergo transcatheter aortic valve replacement are well described in the literature. Some of these trends are driven by the decreasing risk profile of patients because of changing indications for transcatheter aortic valve replacement. We aimed to evaluate these trends in different age groups and quantify how much of these trends are driven by changes in procedural characteristics. Methods and Results Using the National Inpatient Sample from 2012 to 2018, we identified 204 230 adult patients who underwent transfemoral aortic valve replacement. The study's primary objective was to evaluate the changes in age‐based trends in in‐hospital mortality driven by changes in procedural characteristics over time. The secondary objectives were to evaluate similar trends in cardiac and noncardiac complications and resource use. Univariate and multivariate linear and logistic regression were used to obtain effect sizes. From 2012 to 2018, in‐hospital mortality decreased from 1.8% to 0.79% in the age group 18 to 64 years, from 3.8% to 1.6% in the age group 65 to 80 years, and from 5.3% to 1.5% in the age group >80 years ( P trend<0.01 for all age groups); these trends remained statistically significant on adjusted analysis except in patients aged 18 to 64 years. The other outcomes also showed variable trends over time. Length of stay, cost, and early discharge rates improved even after adjusting for comorbidities, which is likely attributable to improvement in procedural characteristics. Conclusions The changes in outcomes related to transcatheter aortic valve replacement are partly driven by changing patient risk profiles over time, but procedural characteristics have likely contributed to these trends in all age groups.
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Ashraf et al. (2022) conducted a cohort in Severe aortic stenosis requiring transfemoral transcatheter aortic valve replacement (n=204,230). Transfemoral Transcatheter Aortic Valve Replacement (2012-2018 trends) vs. Earlier procedure years (e.g., 2012) compared to later procedure years (e.g., 2018) was evaluated on In-hospital mortality (trend per year in patients aged >80 years) (Adjusted OR 0.89 per year, 95% CI 0.84-0.94, p=<0.01). From 2012 to 2018, in-hospital mortality for transfemoral TAVR significantly decreased, with an adjusted OR of 0.89 per year (p<0.01) for patients over 80 years old.
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