Abstract 13019: Differences in Outcomes Among Elderly Patients on Medicare Undergoing Transapical Access and Non-Transapical Access Transcatheter Aortic Valve Replacement

Abstract

Introduction: While a recent study reported a decreasing trend in the use of transapical access (TA) transcatheter aortic valve replacement (TAVR) over non-transapical access (non-TA) TAVR, their burden on Medicare remains considerable. We aim to investigate differences in outcomes among elderly patients covered by Medicare undergoing TA and non-TA-TAVR. Methods: Medicare-insured elderly (ages≥ 60 years) undergoing TAVR (TA and non-TA) were recruited from the National Inpatient Sample (2016-2020), and differences in outcomes between the two procedures were evaluated. Results: We found 259385 procedures of TAVR involving 256145 (98.8%) cases of non-TA-TAVR and 3240(1.2%) cases of TA-TAVR. Between 2016-2020, a continuous drop in TA-TAVR use was observed (vs. non-TA-TAVR). Mortality rates among non-TA-TAVR patients also decreased from 1.8% in 2016 to 1.1% in 2020. Meanwhile, patients with TA-TAVR experienced a rise in mortality from 3.8% in 2016 to 5.8% in 2018, which decreased in 2019(3.7%) and 2020 (2.2%). TA-TAVR cases had a higher mean Charlson Comorbidity Index (CCI) score (3.65 in TA-TAVR cases vs. 3.02 in non-TA-TAVR patients) and higher odds of major bleeding (aOR 1.554, 95% CI 1.442-1.675, p<0.01), postprocedural pneumothorax (aOR 2.853, 95% CI 1.689-4.820, p<0.01), postprocedural respiratory failure (aOR 5.106, 95% CI 4.149-6.284, p<0.01), use of mechanical ventilation (aOR 3.077, 95% CI 2.653-3.569, p<0.01), or Major Adverse Cardiac Events (MACE) (aOR 1.512, 95% CI 1.325-1.727, p<0.01) vs. non-TA-TAVR cases. No differences in cardiac tamponade (aOR 1.350, 95% CI 0.957-1.904, p=0.087) were seen. Finally, TA-TAVR cases required a longer stay (mean length of stay 7.15 vs. 3.76 days). Conclusions: The use of non-TAVR over TA-TAVR continued between 2016-2020 with favorable short-term survival rates and fewer complications such as major bleeding, postprocedural pneumothorax, respiratory failure, MACE, and the need for mechanical ventilation.