TAVI en la curva de aprendizaje en España. Resultados intrahospitalarios comparados con la sustitución valvular aórtica

Abstract

Introduction and objectivesTranscatheter aortic valve implantation (TAVI) has been postulated as an alternative to surgical replacement (SAVR). The results of both procedures were compared using the Minimum Basic Data Set of the National Health System (NHS). MethodsRetrospective observational study. Patients discharged from Spanish National Health System hospitals who underwent a SVA or TAVI procedure between 2014 and 2015. Outcome variables analysed: in-hospital mortality, length of stay and complication rate. In-hospital mortality was adjusted by risk (multilevel logistic regression) and length of stay by severity, also contrasting in-hospital mortality between TAVI and SVA using propensity score matching. ResultsAmong 17 343 identified procedures of TAVI or SVA, we selected 1725 TAVI and 8616 isolated valvular SVA. TAVI patients had higher mean age (81.1±6.6 vs 70.2±11.4 years; P <.001), higher proportion of women (52.2% vs 42.9%; P <.001) and more comorbidities (Charlson index: 7.2±1.6 vs 6.5±1.7; P <.001). The raw in-hospital mortality was 4.46% in TAVI and 4.53% in SVA. TAVI showed lower risk-adjusted in-hospital mortality than SVA (OR, 0.58; 95%CI, 0.44-0.7; P <.001), also being found using propensity score matching (OR, 0.49; 95%CI, 0.36-0.66; χ2, P <.001). The adjusted mean stay was higher in SVA. ConclusionsIn the 2014-5 period, for a population more complex than those undergoing SVA, TAVI showed less mortality and mean stay with higher rate of some non-fatal in-hospital events than SVA.