Abstract 16954: Should We Perform Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Obstructive Sleep Apnea? A Nationwide Inpatient Sample Matched Analysis

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an established alternative treatment strategy to surgical aortic valve replacement (SAVR) in select patients with severe aortic stenosis (AS). Obstructive sleep apnea (OSA) is associated with increased perioperative morbidity and mortality. We sought to compare the in-hospital outcomes after SAVR and TAVR in patients with severe AS and OSA. Methods: We identified patients who underwent either SAVR or TAVR in the Nationwide Inpatient Sample (NIS) between 2012 and 2015 using ICD-9-CM procedure codes 35.21, 35.22 and 35.05, 35.06, respectively. We identified OSA with code 327.23. A 1:1 propensity-matched cohort was created to examine the primary endpoint of in-hospital mortality. Secondary endpoints included hospital length of stay (LOS), cost, and post-procedural complications. Results: We identified 1113 matched-pairs of TAVR and SAVR patients. The need for non-invasive ventilation was similar between TAVR and SAVR, respectively (9.3% vs. 10.4%, OR 0.88, p=0.36). However, TAVR patients had fewer respiratory complications, including pneumonia (0.5% vs. 1.3%, OR 0.43, p=0.08), acute respiratory failure (12.8% vs. 23.4%, OR 0.48), re-intubation (3.3% vs. 8.0%, OR 0.40), and tracheostomy (0.5% vs. 3.0%, OR 0.18), all p<0.001. TAVR was also associated with significantly lower rates of acute myocardial infarction (1.9% vs. 4.7%, OR 0.39, p<0.001), bleeding requiring blood transfusion (14.0% vs. 38.0%, OR 0.27, p<0.001), and acute kidney injury (5.1% vs. 7.4%, OR 0.68, p<0.03). However, TAVR did portend a greater risk of permanent pacemaker (PPM) implantation (24.7% vs. 6.8%, OR 4.55, p <0.001). Although in-hospital mortality was similar between TAVR and SAVR (2.8% vs. 2.3%, OR 1.19, p=0.51), TAVR was associated with lower total median cost and shorter LOS ($206,585 vs. $222,805.50, p<0.012 and 5 vs. 8 days, p<0.001, respectively). Conclusions: In patients with severe AS and OSA, in-hospital mortality was comparable between TAVR and SAVR. Aside from higher risk of PPM implantation, TAVR was associated with significantly less post-operative complications, decreased total cost, and shorter LOS. These findings suggest that TAVR may be the preferred option in patients with severe AS and OSA.