Key result
Transcatheter aortic valve replacement utilization increased from 18.0% to 62.3% (p<0.001) and was associated with lower inpatient mortality and complications compared to surgical replacement.
Why the study?
Contemporary national trends of comorbidities, outcomes, and health care resource utilization in patients with aortic stenosis and end-stage renal disease undergoing TAVR versus SAVR needed to be assessed.
Does TAVR improve inpatient outcomes and resource utilization compared to SAVR in patients with aortic stenosis and end-stage renal disease?
Observational (n=12,550)
Yes
Does TAVR improve inpatient outcomes and resource utilization compared to SAVR in patients with aortic stenosis and end-stage renal disease?
In patients with aortic stenosis and end-stage renal disease, TAVR is associated with lower inpatient mortality, fewer complications, and reduced resource utilization compared to SAVR, despite a higher baseline comorbidity burden.
Hypothesis-generating for TAVR preference in AS-ESRD; leaves open RCTs before practice change.
OBJECTIVE: To assess contemporary national trends of comorbidities, outcomes, and health care resource utilization in patients with aortic stenosis (AS) and end-stage renal disease (ESRD) undergoing transcatheter and surgical aortic valve replacement (TAVR and SAVR). METHODS AND RESULTS: The National-Inpatient-Sample was used to study trends in patients with AS and ESRD undergoing TAVR and SAVR between January 2012 and December 2017. Of 12,550 patients, 5,735 underwent TAVR and 6,815 underwent SAVR. Over the years, the utilization of SAVR declined (from 82.0 to 37.7%); and increased for TAVR (from 18.0 to 62.3%; p < .001). Patients receiving TAVR were older (74.6 [9.1] vs. 66.8 years [9.1]), had a higher proportion of females (37.1 vs. 32.5%), Caucasians (68.7 vs. 60.9%) and Asian /Pacific Islanders (3.1 vs. 2.7%; p < .001 for all). The TAVR patients, despite having higher comorbidity burden (anemia, coronary artery disease, chronic pulmonary disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease) had lower inpatient mortality and complications (ST-elevation myocardial infarction, pneumonia, pneumothorax, pulmonary embolism, cardiogenic shock, cardiac arrest, and need for mechanical ventilators and vasopressors). The median length of stay (13.9-6.5 days; p < .001) and cost of stay ($311,538.16 to $255,693.40; p < .001) reduced with TAVR; but remained unchanged with SAVR. Higher proportion of patients was discharged home after TAVR vs. SAVR. CONCLUSION: Among patients with AS and ESRD, despite providing therapy to subjects with higher comorbidity burden, TAVR was associated with lower inpatient mortality, complications, length of stay, cost of care, and higher home disposition rates when compared with SAVR.
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Kalra et al. (2020) conducted an observational in Aortic stenosis and end-stage renal disease (n=12,550). Transcatheter aortic valve replacement vs. Surgical aortic valve replacement was evaluated on Inpatient mortality, complications, length of stay, and cost of care. Transcatheter aortic valve replacement utilization increased from 18.0% to 62.3% (p<0.001) and was associated with lower inpatient mortality and complications compared to surgical replacement.
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