Readmission-related outcomes of surgical versus transcatheter aortic valve replacement in patients aged 65 or older with bicuspid aortic valve

Takuya Ogami; Sarah Yousef; James A Brown; Dustin E Kliner; Catalin Toma; Derek Serna-Gallegos; Nandini Doshi; Yisi Wang; Ibrahim Sultan

doi:10.1016/j.carrev.2024.01.009

Readmission-related outcomes of surgical versus transcatheter aortic valve replacement in patients aged 65 or older with bicuspid aortic valve

Cardiovasc Revasc Med. 2024 Jan 15:S1553-8389(24)00010-1. doi: 10.1016/j.carrev.2024.01.009. Online ahead of print.

Authors

Takuya Ogami¹, Sarah Yousef¹, James A Brown¹, Dustin E Kliner², Catalin Toma², Derek Serna-Gallegos³, Nandini Doshi¹, Yisi Wang⁴, Ibrahim Sultan⁵

Affiliations

¹ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
² Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
³ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: sultani@upmc.edu.

PMID: 38233251
DOI: 10.1016/j.carrev.2024.01.009

Abstract

Background: There continues to be debate regarding the superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valves (BAV). We aimed to compare outcomes during readmissions in elderly patients with BAV who underwent SAVR or TAVR.

Methods: Patients 65 years or older with BAV who underwent TAVR or isolated SAVR were identified using the National Readmission Database from 2012 through 2018. We compared outcomes during readmissions within 90 days after discharge from the index surgery. Propensity score matching was performed to adjust the baseline differences.

Results: During the study period, 8555 and 1081 elderly patients with BAV underwent SAVR and TAVR, respectively. The number of patients who underwent TAVR went up by 179 % from 2012 to 2018. Propensity score matching yielded 573 patients in each group. A total of 111 (19.4 %) in the SAVR group and 125 (21.8 %) in the TAVR group were readmitted within 90 days after the index surgery (p = .31). The mortality during the readmissions within 90 days was equivalent between the two groups (0.9 % in the SAVR group vs. 3.2 % in the TAVR group, p = .22). However, the median hospital cost was approximately doubled in the TAVR group during the readmission (18,250 dollars vs. 9310 dollars in the SAVR group, p < .001).

Conclusions: Readmission within 90 days was common in both groups. While the mortality during the readmissions after the surgery was equivalent between the two groups, hospital cost was significantly more expensive in the TAVR group.

Keywords: Bicuspid valve; Surgical aortic valve replacement; Transcatheter aortic valve replacement.