Key result
In octogenarians, TAVR was associated with significantly shorter length of stay (MD -3.29 days; 95% CI -3.82 to -2.75) and lower odds of transfer to a skilled nursing facility compared with SAVR.
Why the study?
Octogenarians have low physiologic reserve and may benefit more from TAVR than SAVR.
Does transcatheter aortic valve replacement improve in-hospital outcomes compared to surgical aortic valve replacement in octogenarians?
Cohort (n=28,960)
Yes
Does transcatheter aortic valve replacement improve in-hospital outcomes compared to surgical aortic valve replacement in octogenarians?
In octogenarians, TAVR is associated with shorter length of stay, better discharge disposition, and lower rates of acute kidney injury and bleeding compared to SAVR, without a significant difference in in-hospital mortality.
Answers are grounded in this paper and cite their sources.
TAVR linked to shorter stays and fewer complications than SAVR in octogenarians; leaves open survival benefit and whether it should change practice.
Background Octogenarians have low physiologic reserve and may benefit more from transcatheter aortic valve replacement ( TAVR ) than surgical aortic valve replacement ( SAVR ). Methods and Results This retrospective cohort study based on the National Inpatient Sample included octogenarians who underwent TAVR or SAVR from 2012 to 2015. Crude and standardized-morbidity-ratio-weighted regression models were used to compare in-hospital outcomes. Among 19 145 TAVR and 9815 SAVR hospitalizations, TAVR patients had higher Charlson Comorbidity Index ( CCI ) scores (2.0 versus 0.8, P<0.0001) than SAVR patients. Before weighting, TAVR was associated with significantly shorter length of stay, more home discharges, and lower incidences of acute kidney injury, bleeding, and cardiogenic shock. Associations were consistent across Charlson Comorbidity Index, except for TAVR being associated with greater length of stay reductions among patients with Charlson Comorbidity Index ≥2, compared with Charlson Comorbidity Index <2 (change in estimate -3.56 versus -2.61 days, P=0.004). After weighting, TAVR patients had significantly shorter length of stay (change in estimate -3.29 days, 95% CI -3.82, -2.75) and lower odds of transfer to skilled nursing facility (odds ratio 0.34, 95% CI 0.29, 0.41), acute kidney injury (odds ratio 0.55, 95% CI 0.45, 0.68), bleeding (odds ratio 0.44, 95% CI 0.37, 0.53), and cardiogenic shock (odds ratio 0.55, 95% CI 0.33, 0.92), compared with SAVR patients. Odds of permanent pacemaker implantation, transient ischemic attack/stroke, vascular complications, and in-hospital mortality were not significantly different. Conclusions TAVR may be preferred over SAVR in high-risk octogenarians because of shorter length of stay, better discharge disposition, and less acute kidney injury, and bleeding. All octogenarians may benefit more from TAVR , irrespective of comorbidity burden, but additional research is needed to confirm our findings.
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Sheng et al. (2019) conducted a cohort in Aortic valve disease requiring replacement (n=28,960). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Length of stay (MD -3.29, 95% CI -3.82, -2.75). In octogenarians, TAVR was associated with significantly shorter length of stay (MD -3.29 days; 95% CI -3.82 to -2.75) and lower odds of transfer to a skilled nursing facility compared with SAVR.
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