Abstract EP11: Long-term Outcomes Of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement: A Retrospective Cohort Study With Overlap Propensity Score Weighting

Abstract

Objectives: This longitudinal observational study utilized surgical procedure data from Ontario, Canada to compare mid- and long-term clinical outcomes in a representative real-world cohort of patients (2007-2019) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Methods: A novel overlap weighting propensity score method was used to match patients on the date of TAVR or SAVR, conditional on baseline patient characteristics. Primary outcomes were all-cause and cardiovascular mortality either in-hospital or at 1, 3 and 5 years post-discharge. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, acute kidney injury, vascular complications, atrial fibrillation, endocarditis, permanent pacemaker implantation, defibrillator, reintervention, and cause-specific readmission at 1, 3 and 5 years post-discharge. In-hospital outcomes were compared using multivariable logistic regression. Long-term primary and secondary outcomes for patients undergoing TAVR vs. SAVR were compared using an overlap propensity score-weighted competing risks sub-distribution proportional hazards model. Results: The study included 9,355 SAVR and 2,641 TAVR patients. Hazards of all-cause mortality at 1 year (Hazard Ratio [HR], 1.25; 95% CI, 1.06-1.48), 3 years (HR, 1.48; 95% CI, 1.31-1.68) and 5 years (HR, 1.51; 95% CI, 1.36-1.69) were significantly higher in the TAVR compared to SAVR group. Cardiovascular mortality was significantly higher in the TAVR group at 3 (HR, 1.40; 95% CI, 1.08-1.80) and 5 years (HR, 1.41; 95% CI, 1.13-1.77). Non-cardiovascular mortality was also significantly higher in the TAVR group at 1 year (HR, 1.46; 95% CI, 1.03-2.06), 3 years (HR, 1.48; 95% CI, 1.17-1.88), and 5 years (HR, 1.41; 95% CI, 1.16-1.72). Hazards of myocardial infarction were significantly greater in the TAVR at 1 year (HR, 1.72; 95% CI, 1.08-2.74), 3 years (HR, 1.86; 95% CI, 1.35-2.57), and 5 years (HR, 1.82; 95% CI, 1.37-2.42). Hazards of angina readmission were significantly greater in the TAVR at 3 years (HR, 1.94; 95% CI, 1.26-3.00) and 5 years (HR, 1.87; 95% CI, 1.26-2.78). Conclusions: In real-life patients who underwent a TAVR experienced an excess cardiac and non-cardiac mortality compared to SAVR. More studies with long-term follow-up are needed to confirm the long-term clinical benefits of TAVR and effort to improve patient selection are warranted.