Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison.

Published

Journal Article

Randomized trials support the use of transcatheter aortic valve replacement (TAVR) for the treatment of aortic stenosis in high- and intermediate-risk patients, but the generalizability of those results in clinical practice has been challenged.The aim of this study was to determine the safety and effectiveness of TAVR versus surgical aortic valve replacement (SAVR), particularly in intermediate- and high-risk patients, in a nationally representative real-world cohort.Using data from the Transcatheter Valve Therapy Registry and Society of Thoracic Surgeons National Database linked to Medicare administrative claims for follow-up, 9,464 propensity-matched intermediate- and high-risk (Society of Thoracic Surgeons Predicted Risk of Mortality score ≥3%) U.S. patients who underwent commercial TAVR or SAVR were examined. Death, stroke, and days alive and out of the hospital to 1 year were compared, as well as discharge home, with subgroup analyses by surgical risk, demographics, and comorbidities.In a propensity-matched cohort (median age 82 years, 48% women, median Society of Thoracic Surgeons Predicted Risk of Mortality score 5.6%), TAVR and SAVR patients experienced no difference in 1-year rates of death (17.3% vs. 17.9%; hazard ratio: 0.93; 95% confidence interval [CI]: 0.83 to 1.04) and stroke (4.2% vs. 3.3%; hazard ratio: 1.18; 95% CI: 0.95 to 1.47), and no difference was observed in the proportion of days alive and out of the hospital to 1 year (rate ratio: 1.00; 95% CI: 0.98 to 1.02). However, TAVR patients were more likely to be discharged home after treatment (69.9% vs. 41.2%; odds ratio: 3.19; 95% CI: 2.84 to 3.58). Results were consistent across most subgroups, including among intermediate- and high-risk patients.Among unselected intermediate- and high-risk patients, TAVR and SAVR resulted in similar rates of death, stroke, and DAOH to 1 year, but TAVR patients were more likely to be discharged home.

Full Text

Duke Authors

Cited Authors

  • Brennan, JM; Thomas, L; Cohen, DJ; Shahian, D; Wang, A; Mack, MJ; Holmes, DR; Edwards, FH; Frankel, NZ; Baron, SJ; Carroll, J; Thourani, V; Tuzcu, EM; Arnold, SV; Cohn, R; Maser, T; Schawe, B; Strong, S; Stickfort, A; Patrick-Lake, E; Graham, FL; Dai, D; Li, F; Matsouaka, RA; O'Brien, S; Pencina, MJ; Peterson, ED

Published Date

  • July 2017

Published In

Volume / Issue

  • 70 / 4

Start / End Page

  • 439 - 450

PubMed ID

  • 28728688

Pubmed Central ID

  • 28728688

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

International Standard Serial Number (ISSN)

  • 0735-1097

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2017.05.060

Language

  • eng