Abstract 11203: Providing Transcatheter Aortic Valve Replacement Therapies to VA Patients Through a Public-Private Partnership

Abstract

Introduction: Despite the success of Transcatheter Aortic Valve Replacement (TAVR) in improving morbidity and mortality among patients with aortic stenosis, few stand-alone programs currently exist within the VA system. Many VA centers have developed transfer arrangements with partner institutions to provide TAVR for their patients. There is minimal data for VA patients in such programs. We compared the outcomes of VA patients to non-VA patients undergoing TAVR at a partner institution. Methods: We performed a single-center retrospective study on all patients undergoing TAVR between March 2018 and June 2020. All procedures were performed at an academic medical center (AMC) in Chicago where VA patients were referred for TAVR. Primary outcomes included composite MACE (death from any cause, MI, CVA). Secondary outcomes included length of stay, bleeding events, AKI, change in ejection fraction, CHF exacerbations, and device-related complications. We assessed outcomes at hospital discharge, 6-month and 12-months. Results: There was a total of 115 patients (AMC: 56, VA: 59). Patient demographics between the two groups were significant for the VA group being 57.6% Caucasian and 96.6% male while the AMC group was 33.9% Caucasian and 56.6% male (for both p<0.01). There was no in-hospital mortality in either group. Total length of stay (p=0.6), ICU length of stay (p=0.4), procedure time (p=0.4) and baseline ejection fraction (p=0.8) were similar between both groups. At 6 months, the VA patients experienced a trend towards a higher incidence of composite MACE (VA: 11.9%, AMC: 5.4%, p=0.2). None of the secondary outcomes reached statistical significance. Ejection fraction and CHF exacerbations were similar between groups (p=0.9 and p=0.59). At 12 months there was no statistical difference in primary or secondary outcomes. Similar ejection fractions and CHF exacerbations at 12 months were also recorded. Conclusions: No difference between procedural, 6-month or 12-month outcomes between VA patients and non-VA patients undergoing TAVR were observed. Public-private partnerships can provide state of the art therapies to VA patients in an efficient and safe manner.