Abstract
Background: Traditionally, the only effective treatment for aortic stenosis was surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011 and provided a critical alternative therapy. Our aims were to investigate the trends in the utilization of SAVR in the early vs. late TAVR era and to assess SAVR and TAVR outcomes.Methods: Using the 2011–2017 National Inpatient Sample database, we identified hospitalizations for patients with a most responsible diagnosis of aortic stenosis during which an aortic valve replacement (AVR) was performed, either SAVR or TAVR. Patients' sociodemographic and clinical characteristics, procedure complications, length of stay, and mortality were analyzed. Multivariable analyses were performed to identify predictors of in-hospital mortality. Piecewise regression analyses were performed to assess temporal trends in SAVR and TAVR utilization.Results: A total of 542,734 AVR procedures were analyzed. The utilization of SAVR was steady until 2014 with a significant downward trend in the following years 2015–2017 (P = 0.026). In contrast, a steady upward trend was observed in the TAVR procedure with a significant increase during the years 2015–2017 (P = 0.006). Higher in-hospital mortality was observed in SAVR patients. The mortality rate declined from 2011 to 2017 in a significantly higher proportion in the TAVR compared with the SAVR group.Conclusion: Utilization of SAVR showed a downward trend during the late TAVR era (2015–2017), and TAVR utilization demonstrated a steady upward trend during the years 2011–2017. Higher in-hospital mortality was recorded in patients who underwent SAVR.
Highlights
Since the first human transcatheter aortic valve replacement (TAVR) performed in 2002, TAVR has rapidly transitioned from an innovative procedure intended for compassionate use to the standard of care for elderly patients with severe symptomatic aortic stenosis (AS)
We identified patients 18 years of age or older with a primary diagnosis of AS based on ICD-9-CM codes 395.0, 395.2, 396, 396.2, 746.3, and 424.1 and based on ICD-10CM codes I35.0, I35.2, Q23.0, I06.0, I06.2, and I08.0, who underwent in-hospital surgical aortic valve replacement (SAVR) or TAVR based on ICD-9-CM procedure codes for PR1-PR15
There were significantly older patients in the TAVR group compared with the SAVR group (80.6 + 8.2 vs. 69.4 + 11.7, respectively)
Summary
Since the first human transcatheter aortic valve replacement (TAVR) performed in 2002, TAVR has rapidly transitioned from an innovative procedure intended for compassionate use to the standard of care for elderly patients with severe symptomatic aortic stenosis (AS). In 2004, highsurgical-risk TAVR feasibility studies were initiated, leading to the Conformité Européenne (CE) mark being granted in 2007 [2,3,4] followed by FDA and Health Canada approval in 2011 [3, 5]. Over this period, more than 500,000 procedures have been performed in more than 70 countries [3, 6]. Our aims were to investigate the trends in the utilization of SAVR in the early vs. late TAVR era and to assess SAVR and TAVR outcomes
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