Key result
TAVR linked to ~30% lower in-hospital mortality vs. SAVR in patients with pulmonary hypertension.
Why the study?
Pulmonary hypertension is a risk factor for worse outcomes after surgical or transcatheter aortic valve replacement, but its impact on in-hospital outcomes comparing both treatments was unclear.
Does TAVR improve in-hospital outcomes compared to SAVR in patients with aortic valve stenosis and pulmonary hypertension?
Cohort (n=107,057)
Yes
Does TAVR improve in-hospital outcomes compared to SAVR in patients with aortic valve stenosis and pulmonary hypertension?
Odds Ratio: 0.7
p-value: p=0.005
In patients with aortic stenosis and pulmonary hypertension, TAVR is associated with lower in-hospital mortality, stroke, and bleeding compared to SAVR, suggesting a preference for the transcatheter approach in this high-risk population.
PH signals higher in-hospital risk in SAVR/TAVR; extends large observational data but leaves causality and practice change open.
AIMS: We aimed to analyse the impact of pulmonary hypertension (PH) on the in-hospital outcome of either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Data from all 107,057 patients undergoing isolated SAVR or TAVR in Germany between 2007 and 2014 were provided by the German Federal Bureau of Statistics. About 18% of patients with aortic valve stenosis suffered from PH. Patients with PH had more comorbidities with consequently increased EuroSCORE (TAVR without PH: 12.3%; with PH: 24%). The presence of PH led to an increase of in-hospital strokes, bleedings, acute kidney injuries, and pacemaker implantations in both treatment groups (TAVR and SAVR), but the PH-associated increase of complications and mortality was less pronounced among patients receiving TAVR (mortality after TAVR without PH: 5.4%; with PH: 7.2%). After baseline risk adjustment, the TAVR procedure was associated with a reduced risk of in-hospital stroke (OR 0.81, p=0.011), bleeding (OR 0.22, p<0.001), and mortality (OR 0.70, p=0.005) among PH patients, and in comparison to surgical treatment. CONCLUSIONS: PH is a risk factor for worse outcome of SAVR and TAVR. This fact is less pronounced among TAVR patients. Our data suggest a shift towards the transcatheter approach in patients suffering from PH.
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Gutmann et al. (2017) conducted a cohort in aortic valve stenosis (n=107,057). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on in-hospital mortality (OR 0.70, p=0.005). Among patients with pulmonary hypertension, TAVR was associated with a reduced risk of in-hospital mortality compared to surgical aortic valve replacement (OR 0.70, p=0.005).
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