Abstract 12918: COVID-19 Has Not Decreased the Volume of Transcatheter Aortic Valve Replacements Performed in the United States

Abstract

Introduction: Transcatheter aortic valve replacement (TAVR) is the predominant technique for aortic valve replacements. The COVID19 pandemic caused significant disruptions to hospital procedural and surgical volume and revenue, which could affect patients with aortic stenosis. Hypothesis: The COVID-19 pandemic may have decreased the volume of TAVRs in the United States. Methods: The National Readmission Database (NRD) was reviewed for all adults from 2012 to 2017 who underwent a TAVR procedure based on ICD 9 and 10 coding. A linear regression based on year and quarter was used to project the trend of volume and cost through the end of 2020. Institutional TAVR volume was compared from 2020 to 2019 to generate an estimate of COVID’s effect on volume. This trend effect was utilized for the 2020 projections to create national estimates of changes in volume and hospital costs. The NRD weights were used to generate national estimates, charge-cost ratios were used to convert hospital charges to hospital costs, and all monetary values were adjusted to 2020 dollars via the GDP. Results: A total of 172,546 TAVR procedures were performed. TAVR volume has been increasing since 2012 with an estimated 21,516 cases in the last quarter of 2020 ( Figure 1A). The linear regression was well fit with a R 2 of 0.995. Similarly, hospital costs of TAVR have been increasing since 2012 with a projected 4.18 billion dollars in 2020 (Figure 1B) . The linear regression was also well fit with a R 2 of 0.968. There were two quarters in which hospital volume outperformed predicted values and two in which it underperformed (Figure 1C). Throughout the pandemic, there was a net increase of 1,918 TAVR procedures and an associated increase of 114 million dollars in hospital costs. Conclusions: TAVR volumes have been steadily increasing, with commensurate escalation in hospital hosts. The COVID-19 pandemic has caused minimal derailment to this trend, with an actual increase in volume and hospital costs during this time.