Clinical Outcomes in Surgical and Transcatheter Aortic Valve Replacement: An ANZSCTS Database Review 2001-2019

Abstract

Since the last formal publication reporting on the findings of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database on surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in 2016, transcatheter approaches have become common practice. There has been an increase in use of TAVR following large, randomised control trials that only report on short-term outcomes in a selective cohort. This study aims to report on primary outcome measures and identify complications associated with SAVR and TAVR from a large national database. From the ANZSCTS database (2001-19), 14,097 SAVR and 1,194 TAVR patients were identified with clinical details and 30-day follow-up available. The primary endpoint was the composite of all-cause mortality and/or permanent stroke at 30 days. Secondary endpoints were post-procedure complications requiring treatment. Logistical regression followed by propensity score matching was performed. Using logistical regression when all patient factors considered for all patients who had SAVR and TAVR, the only preoperative factors that had an impact on 30-day mortality was cerebrovascular disease, respiratory disease, preoperative dialysis, angina, and hypertension. Primary outcome 30-day mortality rate was 1.83% in the SAVR group, and 1.68% in patients in the TAVR group, p=0.7001, and permanent stroke was seen in 1.07% patients in the SAVR group, and 1.26% patients in the TAVR group. Acute limb ischaemia, aortic dissection, ventricular tachycardia, bradyarrhythmia and heart block were more common following TAVR (p<0.001), while reintubation and atrial arrhythmia were more common following SAVR (p<0.001). In the real world SAVR and TAVR have been used in very different patient groups and it is difficult to compare as different baseline characteristics and complications. The two patient groups maintain similarities in primary and secondary endpoints, but differences in life threatening and life altering morbidity remains significant. Collection of SAVR and TAVR data in a combined database may help to better capture and compare these complications and institute strategies to prevent them.