PSU3 Clinical Outcomes and Economics Associated with Surgical Aortic Valve Replacement in Taiwan

Abstract

Currently aortic valve replacement is the gold standard treatment for Severe Symptomatic Aortic Valve Disease (SSAVD) and can be performed using 1 of 3 types of valves: mechanical (MV), porcine (PV), and bovine (BV). However, national-based research on mortality and medical resource utilization of surgical aortic valve replacement (SAVR) are lacking in Taiwan. The objective of this study is to understand the clinical outcomes and costs associated with SAVR for each valve type, amongst the Taiwanese population. Taiwan’s National Health Insurance Research Database (NHIRD) was used to conduct a retrospective cohort study investigating patients who received an isolated SAVR in Taiwan from 2000 to 2017. 10,725 patients with International Classification of Diseases (ICD) diagnosis codes associated with aortic valve disorders in inpatient care settings whom received a valve replacement were included. Mitral valve disease patients were excluded. We built Kaplan-Meier curves for each group and compared unadjusted survival statistics using Log-rank test. Patients receiving a BV or MV showed lower all-cause mortality rates than those receiving a PV (p<0.001). We subdivided these patients into three age groups (≦50, 51-70 and ≧71) to analyse their mortality rates separately. In all age groups, the mortality rate of patients with BV replacement was lower than PV and MV (p<0.001). PV patients had the highest length of stay in patients between year 2014 to 2017 at 22.6 days (p<0.001); Mean hospital costs in patients receiving a BV were $16,292, versus $18,117 and $18,771 for PV and MV respectively (p<0.001). These findings indicate there are statistically significant differences in key clinical and economic outcomes depending on what type of valve is used to treat SSAVD. Further studies are needed to understand which valve types optimize clinical and economic outcomes.