November 1, 2019MedicineOpen Access

Surgical versus trans-catheter aortic valve replacement (SAVR vs TAVR) in patients with aortic stenosis

View Full Paper

Ask AI

Bookmark

Why the study?

As TAVR programs expand into community-based institutions, outcomes comparing TAVR to SAVR in a community hospital setting needed evaluation.

Does TAVR improve procedural outcomes and hemodynamics compared to SAVR in patients with aortic stenosis treated in a community hospital?

Structured PICO

Does TAVR improve procedural outcomes and hemodynamics compared to SAVR in patients with aortic stenosis treated in a community hospital?

Population

230 patients with aortic stenosis and pre-post procedure echocardiography data treated at a community hospital (Cape Cod Hospital) between January 2014 and December 2016.

Intervention

Trans-catheter aortic valve replacement (TAVR)

Comparator

Surgical aortic valve replacement (SAVR)

Outcome

Procedure outcomes including 30-day mortality, postoperative aortic regurgitation, atrial ventricular blocks, pacemaker implantation, mean gradient, atrial fibrillation, and length of stay

In a community hospital setting, TAVR provides better hemodynamic performance and lower risk of atrial fibrillation compared to SAVR, but carries a significantly higher risk of requiring a permanent pacemaker.

Implication

TAVR linked to higher pacemaker risk despite hemodynamic and AF benefits versus SAVR; leaves open randomized confirmation in community settings.

Abstract

Trans-catheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. TAVR programs are spreading from large referral centers and being established in community based institutions. The purpose of this study was to compare the outcomes of TAVR to those of SAVR in a community hospital.A historical cohort study of patients with aortic stenosis and pre-post procedure echocardiography data who underwent SAVR or TAVR in Cape Cod Hospital between January 2014 and December 2016. Patient characteristics and procedure outcomes were compared between the two procedures.The study included 230 patients, of them 111 underwent SAVR and 119 underwent TAVR. None of the patients died during the 30 days after the procedure. TAVR patients had higher rates of postoperative mild+ aortic regurgitation (AR) (29.4% vs 12.6%, P = .002), postoperative atrial ventricular blocks (11.8% vs 0.9%, P = .001), and more often need an implantation of pacemaker (16.8% vs 0.9%, P < .001). Postoperative mean gradient of SAVR patients was higher (median 14 vs 11 mm Hg, P = .001) and atrial fibrillation postoperatively was more frequent (18.9% vs 2.5%, P < .001). Length of stay after procedure was shorter in TAVR patients (median 2 vs 4 days, P < .001).After controlling for confounders, the use of TAVR was associated with an increased risk for postoperative pacemaker implantation (OR = 16.3, 95%CI 1.91-138.7, P = .011), lower mean gradient (-4.327, 95%CI -7.68 to -0.98, P = .011), and lower risk for atrial fibrillation (OR = 0.11, 95%CI 0.03-0.38, P = .001), but not with postoperative AR (OR = 0.84, 95%CI 0.22-3.13, P = .789).In conclusion, short-term mortality was not reported in SAVR or TAVR patients. However, TAVR was associated with an increased risk for postoperative pacemaker implantation but with a lower risk for atrial fibrillation. Aortic valves implanted through a trans-catheter approach are also associated with a better hemodynamic performance.