Abstract 16930: Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Pulmonary Hypertension: A Nationwide Inpatient Sample Matched Analysis

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been established as a viable alternative to surgical aortic valve replacement (SAVR) in select patients with severe aortic stenosis (AS). Patients with pulmonary hypertension (PH) are at increased perioperative morbidity and mortality and thus were excluded from the major TAVR trials. We sought to compare the in-hospital outcomes after SAVR and TAVR in patients with severe AS and PH. Methods: We identified patients from the Nationwide Inpatient Sample (NIS) between 2012 and 2015 who underwent SAVR or TAVR using the ICD-9-CM procedure codes 35.21, 35.22 and 35.05, 35.06, respectively. We identified PH with codes 416.0, 416.8, and 416.9. A 1:1 propensity-matched cohort was created to examine the outcomes. Primary endpoint was in-hospital mortality. Secondary endpoints included hospital length of stay (LOS), cost, and post-procedural complications. Results: A matched pair of 670 TAVR and 670 SAVR patients were identified. The respiratory complications were less frequent with TAVR as opposed to SAVR. These included non-invasive ventilation requirement (3.3% vs. 5.8%, OR 0.55, p=0.028), pneumonia (1.5% vs. 4.3% vs. OR 0.33, p=0.003), acute respiratory failure (17.6% vs. 34.0%, OR 0.41), re-intubation (7.5% vs. 14.8%, OR 0.47), and tracheostomy (1.5% vs. 5.7%, OR 0.25), all p<0.001. The non-respiratory complications were also significantly less frequent in the TAVR group, including acute myocardial infarction (3.9% vs. 11.5%, OR 0.31), bleeding requiring blood transfusion (17.0% vs. 41.3%, OR 0.29), and acute kidney injury (11.5% vs. 22.4%, OR 0.45), all p<0.001. Permanent pacemaker (PPM) implantation was the only complication which was significantly higher in the TAVR group (24.6% vs. 11.8%, OR 2.43, p<0.001). Lastly, TAVR was associated with a significantly reduced risk of in-hospital mortality, total median cost, and shorter LOS (4.0% vs. 6.9%, OR 0.57, p=0.024, $171,496.0 vs. $218,625.4, p<0.001, and 5 vs. 12 days <0.001, respectively). Conclusions: Patients with PH undergoing TAVR had lower risk of in-hospital mortality, post-operative complications, shorter LOS and reduced overall cost compared to patients undergoing SAVR. Aside from higher risk of PPM implantation, TAVR may be the preferred option in this patient population.