A. Iyengar1, E. Aguayo1, Y. Seo1, K. L. Bailey1, Y. Sanaiha3, O. Kwon2, W. Toppen4, P. Benharash2 1University Of California – Los Angeles,David Geffen School Of Medicine,Los Angeles, CA, USA 2University Of California – Los Angeles,Cardiac Surgery,Los Angeles, CA, USA 3University Of California – Los Angeles,General Surgery,Los Angeles, CA, USA 4University Of California – Los Angeles,Internal Medicine,Los Angeles, CA, USA
Introduction:
Late bleeding complications are known to contribute to morbidity in patients undergoing aortic valve repair. In particular, post-hoc analysis of the PARTNER study has highlighted the high prevalence and morbidity of late bleeding complications in both surgical (SAVR) & transcatheter (TAVR) aortic valve replacement in high-risk populations. The purpose of this study was to compare the incidence and financial impact of late gastrointestinal (GI) bleeding in transcatheter and surgical (SAVR) aortic valve replacements.
Methods:
Retrospective analysis of the National Readmissions Database was performed between January 2012 & December 2014 using the International Classification of Diseases, Ninth Revision procedural codes for TAVR (35.05 and 35.06) and SAVR (35.21 and 35.22), and diagnosis codes for GI bleeding (578.9). Costs were standardized to the 2014 US gross domestic product using US Department of Commerce consumer price indices and adjusted for diagnosis related group–based severity. The Kruskal-Wallis and chi-squared tests were used for comparisons between all cohorts. Multivariable logistic regression models were utilized to identify significant predictors for GI bleeding.
Results:
Overall, 32,796 patients were identified who underwent TAVR, while 231,324 patients underwent SAVR. Compared to SAVR, TAVR patients were older (82 vs. 69 years, p<0.001) and more likely to be female (46% vs. 36%, p<0.001). In addition, TAVR patients had higher incidence of congestive heart failure (76% vs. 39%, p<0.001), chronic kidney disease (37% vs. 18%), and higher median Elixhauser Comorbidity Index (6 vs. 5, p<0.001). Hospital length of stay was lower in TAVR compared to SAVR (5 vs. 8 days, p<0.001), but in-hospital mortality rates were similar (p=0.668).
Among the TAVR cohort, 868 (2.6%) of patients were rehospitalized for GI bleeding compared to 2,630 (1.1%) in the SAVR group (p<0.001). Median time to readmission was similar between cohorts (46 vs. 47 days, p=0.948). Average cost of TAVR readmission for GI bleeding was $17,136 compared to $18,737 for SAVR (p=0.392). Amongst the subset of patients over age 80, GI bleeding readmissions remained more prevalent in TAVR vs. SAVR (2.6% vs. 1.5%, p<0.001). After multivariable adjustment, TAVR remained significantly associated with GI bleeding compared to SAVR (AOR 1.73 [1.50-1.99], p<0.001).
Conclusion:
In this national cohort study, TAVR was associated with more frequent readmissions for late GI bleeding compared to SAVR. After controlling for preoperative comorbidities, TAVR remained a significant predictor of late GI bleeding. Since the optimal anticoagulation regimen for TAVR is not known, strategies to reduce GI bleeding in both groups may serve as suitable targets for improvement in overall quality of care.