Transcatheter and Surgical Aortic Valve Replacement Outcomes for Patients with Chronic Heart Failure

Abstract

Objectives: To determine in-hospital outcomes and assess high-risk groups among chronic heart failure (CHF) patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).

Design: A retrospective analysis of the Nationwide Inpatient Sample database from January 2012 to September 2015 was performed.

Setting: Hospitals across the United States that offer TAVRs or SAVRs.

Participants: Adults with a diagnosis of CHF and AS.

Interventions: The patients underwent either TAVR or SAVR.

Measurements and main results: Totals of 5,871 and 4,008 CHF patients underwent TAVR and SAVR, respectively. TAVR patients were significantly older, more were female, and had a higher comorbidity burden. No significant differences in in-hospital mortality were noted between TAVR and SAVR. However, mean length of stay was significantly longer by 3.5 days in the SAVR group, as was the mean total cost. With the exception of complete heart block, permanent pacemaker implantation, and vascular complications, the majority of postoperative events were higher among the SAVR group. Multivariate regression analysis identified postoperative cardiac, respiratory and renal complications as significant predictors of in-hospital mortality for both groups. Additionally, age ≥75 years and vascular complications were significant predictors of mortality for patients undergoing TAVR.

Conclusions: Among CHF patients with symptomatic AS, TAVR had similar in-hospital mortality rate compared with SAVR despite higher comorbidity burden. TAVR patients are at a lower risk of cardiovascular, respiratory, and renal complications and might lead to reduced length of hospital stay and cost. Hence, TAVR may be a safer option in this population.

Keywords: Chronic heart failure; surgical aortic valve replacement; transcatheter aortic valve replacement.