Transcatheter aortic valve replacement was associated with significant annual improvement in 30-day postoperative mortality (annual adjusted HR 0.84; 95% CI 0.80-0.88), reaching 2.37% in 2018.
Cohort (n=37,566)
Yes
Does transcatheter aortic valve replacement improve 30-day postoperative mortality compared to surgical aortic valve replacement in patients undergoing aortic valve replacement?
Between 2011 and 2018 in New York, TAVR utilization grew massively and overtook SAVR, accompanied by continuous and significant improvements in 30-day postoperative mortality for TAVR.
Absolute Event Rate: 2.37% vs 0.97%
BACKGROUND: Population-based utilization trends and outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) remain unknown. OBJECTIVES: To examine the utilization trends and outcomes of TAVR and SAVR in New York using all-inclusive aggregated statewide cardiac registries. METHODS: We described the utilization trends, compared baseline characteristics, and evaluated short-term outcomes of TAVR vs SAVR during 2011-2018 in New York. We applied Cox proportional hazards models to analyze changes in 30-day postoperative mortality for TAVR and SAVR. RESULTS: Of a total 37,566 aortic valve replacement (AVR) patients, 50.8% underwent TAVR and 49.2% received SAVR. TAVR's annual volume increased from 715 in 2012 to 4849 in 2018 (578.18% increase) whereas SAVR's annual volume decreased from 2619 in 2012 to 1855 in 2018 (29.17% decrease). TAVR patients were older, more likely to be female and white, and less likely to be Hispanic. Younger patients (<65 years) and Medicare managed-care patients received TAVR (vs SAVR) a lower percentage of the time relative to older patients (≥65 years) and Medicare fee-for-service patients, respectively. In 2018, the unadjusted 30-day mortality rate was 2.37% for TAVR whereas the rate was 0.97% for SAVR. There was significant annual improvement in 30-day mortality for TAVR (annual adjusted hazard ratio, 0.84, 95% confidence interval, 0.80-0.88) but not for SAVR (annual adjusted hazard ratio, 0.96; 95% confidence interval, 0.91-1.01). CONCLUSION: TAVR and AVR experienced massive growth whereas SAVR decreased in New York. Younger and Medicare managed-care patients had unique utilization trends. TAVR was associated with continuous improvement in 30-day postoperative mortality.
Qian et al. (Fri,) conducted a cohort in Aortic valve replacement (n=37,566). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day postoperative mortality (2018 unadjusted rate). Transcatheter aortic valve replacement was associated with significant annual improvement in 30-day postoperative mortality (annual adjusted HR 0.84; 95% CI 0.80-0.88), reaching 2.37% in 2018.
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