Key result
Transcatheter aortic valve replacement in patients with polyvascular disease was associated with significantly lower in-hospital mortality (OR 0.26) compared with surgical aortic valve replacement.
Why the study?
Data regarding trends and comparative outcomes of TAVR versus SAVR among patients with polyvascular disease were limited.
Does transcatheter aortic valve replacement reduce in-hospital mortality in patients with polyvascular disease compared to surgical aortic valve replacement?
Cohort (n=545,409)
Yes
Does transcatheter aortic valve replacement reduce in-hospital mortality in patients with polyvascular disease compared to surgical aortic valve replacement?
Odds Ratio: 0.26 (95% CI 0.19–0.35)
Absolute Event Rate: 1.1% vs 4%
In patients with polyvascular disease requiring aortic valve replacement, TAVR is associated with significantly lower in-hospital mortality and major cardiovascular complications compared to SAVR, though it carries a higher risk of pacemaker implantation and 90-day readmission.
There is a paucity of data regarding the trends and comparative outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among patients with polyvascular disease (PVD). The Nationwide Readmissions Database (2016–2020) was queried for patients undergoing AVR. Propensity score matching was used to compare the outcomes of TAVR versus SAVR among patients with PVD, and for comparing TAVR among those with versus without PVD. The primary outcome was in-hospital mortality. The final cohort included 545,409 hospitalizations for AVR. During the study years, there was an increase in the utilization of TAVR versus SAVR among patients with PVD. Patients with PVD undergoing TAVR were older and more likely to be women compared with patients with PVD undergoing SAVR. Compared with SAVR, patients with PVD undergoing TAVR had lower odds of in-hospital mortality (adjusted odds ratio (aOR) 0.26; 95% confidence interval (CI) 0.19–0.35), acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, and major bleeding, but higher odds of pacemaker and non-elective 90-day readmissions (aOR 1.13; 95% CI 1.01–1.26). TAVR among patients with versus without PVD showed similar in-hospital mortality (aOR 1.10; 95% CI 0.94–1.20), while there were higher odds of AMI, ischemic stroke, and vascular complications after TAVR in patients with PVD. A higher burden of atherosclerotic vascular beds conferred higher mortality with SAVR more than with TAVR, while a higher burden of atherosclerotic vascular beds conferred a higher risk of ischemic stroke and readmissions after both TAVR and SAVR. Nationwide data demonstrated that patients with PVD who undergo TAVR were associated with lower in-hospital mortality and major cardiovascular complications compared with those who undergo SAVR. Patients with PVD have similar mortality to those with no PVD undergoing TAVR, but were associated with a higher risk for complications and readmission. The Nationwide Readmissions Database (2016–2020) was queried for patients undergoing aortic valve replacement AVR (n = 545,409). There was an increase in the utilization of transcatheter aortic valve replacement (TAVR) in favor of surgical aortic valve replacement (SAVR) among patients with polyvascular disease. Patients with polyvascular disease undergoing TAVR had lower odds of in-hospital mortality, myocardial infarction, ischemic stroke, hemorrhagic stroke, and major bleeding compared with SAVR, but higher odds of pacemaker and non-elective 90-day readmissions. TAVR among patients with versus without polyvascular disease showed similar in-hospital mortality, while there were higher odds of myocardial infarction, ischemic stroke, and vascular complications after TAVR in patients with polyvascular disease. A higher burden of atherosclerotic vascular beds conferred higher mortality with SAVR than with TAVR.
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Abomoawad et al. (2025) conducted a cohort in Aortic stenosis with polyvascular disease (n=545,409). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on In-hospital mortality (OR 0.26, 95% CI 0.19-0.35). Transcatheter aortic valve replacement in patients with polyvascular disease was associated with significantly lower in-hospital mortality (OR 0.26) compared with surgical aortic valve replacement.
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