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

Publication ,  Journal Article
Brennan, JM; Thomas, L; Cohen, DJ; Shahian, D; Wang, A; Mack, MJ; Holmes, DR; Edwards, FH; Frankel, NZ; Baron, SJ; Carroll, J; Thourani, V ...
Published in: J Am Coll Cardiol
July 25, 2017

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 25, 2017

Volume

70

Issue

4

Start / End Page

439 / 450

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Registries
  • Propensity Score
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brennan, J. M., Thomas, L., Cohen, D. J., Shahian, D., Wang, A., Mack, M. J., … Peterson, E. D. (2017). Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison. J Am Coll Cardiol, 70(4), 439–450. https://doi.org/10.1016/j.jacc.2017.05.060
Brennan, J Matthew, Laine Thomas, David J. Cohen, David Shahian, Alice Wang, Michael J. Mack, David R. Holmes, et al. “Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison.J Am Coll Cardiol 70, no. 4 (July 25, 2017): 439–50. https://doi.org/10.1016/j.jacc.2017.05.060.
Brennan JM, Thomas L, Cohen DJ, Shahian D, Wang A, Mack MJ, et al. Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison. J Am Coll Cardiol. 2017 Jul 25;70(4):439–50.
Brennan, J. Matthew, et al. “Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison.J Am Coll Cardiol, vol. 70, no. 4, July 2017, pp. 439–50. Pubmed, doi:10.1016/j.jacc.2017.05.060.
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. Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison. J Am Coll Cardiol. 2017 Jul 25;70(4):439–450.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 25, 2017

Volume

70

Issue

4

Start / End Page

439 / 450

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Registries
  • Propensity Score
  • Male
  • Humans