Y. Juo1, A. Mantha1, P. Benharash1 1University Of California – Los Angeles,Cardiac Surgery,Los Angeles, CA, USA
Introduction:
Surgical aortic valve replacement (SAVR) is considered the standard of care for adults with severe symptomatic aortic stenosis. More recently tanscatheter aortic valve replacement (TAVR) is being utilized in patients with high surgical risk with encouraging results. With rapidly evolving technology, application of TAVR is expected to reach moderate and low-risk cohorts. We aim to examine the national outcomes and costs of SAVR versus TAVR in the first year following US Food and Drug Administration (FDA) market approval of TAVR in the United States.
Methods:
Patients who underwent elective SAVR or TAVR in the year 2013 were identified from Nationwide Inpatient Sample, a longitudinal inpatient health care database with weighted estimates of more than 35 million annual hospitalizations. Baseline demographics, primary diagnoses, income/payer type and hospital characteristics were tabulated. The primary outcome was in-hospital mortality while secondary outcomes included hospital length of stay (LOS) and overall hospitalization cost.
Results:
During the study period, a total of 68,845 discharges after aortic valve replacements were identified from Nationwide Inpatient Sample, 12,125 (17.6%) of which were TAVR. Compared to SAVR, the TAVR patients were more likely to be elderly (> 85 y/o: 42.4% vs 6.1%, p<0.05), less likely to be uninsured or Medicaid recipients (1.2% vs 6.7%, p<0.05), and and less likely to be of low income status (21.2 vs 22.7%, p<0.05). Primary disease severity information was not available in the database. Unadjusted in-hospital mortality was significantly higher among TAVR than SAVR patients (4.62% vs 3.01%, p<0.05). SAVR was associated with a significantly longer mean LOS (9.7 vs 8.6 days, p<0.05) but lower mean overall hospitalization cost ($184,715 vs $218,246, p<0.05).
Conclusion:
Our results demonstrate rapid adoption of TAVR technology in the US in the year following FDA market approval. As expected based on selection criteria, SAVR is associated with less in-hospital mortality and less overall hospitalization cost than TAVR. The post-market mortality in TAVR patients was significantly lower than previously reported in the PARTNER trial. Adoption of TAVR technology and its impact on SAVR warrant further investigation in order to develop optimal decision algorithms for SAVR versus TAVR.