Comparing Trajectory of Surgical Aortic Valve Replacement in the Early vs. Late Transcatheter Aortic Valve Replacement Era

Gabby Elbaz-Greener; Guy Rozen; Fabio Kusniec; Ibrahim Marai; Shemy Carasso; Dennis T Ko; Harindra C Wijeysundera; Ronny Alcalai; David Planer; Offer Amir

doi:10.3389/fcvm.2021.680123

Comparing Trajectory of Surgical Aortic Valve Replacement in the Early vs. Late Transcatheter Aortic Valve Replacement Era

Front Cardiovasc Med. 2021 Jun 22:8:680123. doi: 10.3389/fcvm.2021.680123. eCollection 2021.

Authors

Gabby Elbaz-Greener^{1

2

3}, Guy Rozen^{2

3

4}, Fabio Kusniec^{2

3}, Ibrahim Marai^{2

3}, Shemy Carasso^{2

3}, Dennis T Ko^{5

6

7

8}, Harindra C Wijeysundera^{5

6

7

8}, Ronny Alcalai¹, David Planer¹, Offer Amir^{1

2

3}

Affiliations

¹ Department of Cardiology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
² Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.
³ The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
⁴ Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
⁵ Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
⁶ ICES, Toronto, ON, Canada.
⁷ Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
⁸ Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Traditionally, the only effective treatment for aortic stenosis was surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011 and provided a critical alternative therapy. Our aims were to investigate the trends in the utilization of SAVR in the early vs. late TAVR era and to assess SAVR and TAVR outcomes. Methods: Using the 2011-2017 National Inpatient Sample database, we identified hospitalizations for patients with a most responsible diagnosis of aortic stenosis during which an aortic valve replacement (AVR) was performed, either SAVR or TAVR. Patients' sociodemographic and clinical characteristics, procedure complications, length of stay, and mortality were analyzed. Multivariable analyses were performed to identify predictors of in-hospital mortality. Piecewise regression analyses were performed to assess temporal trends in SAVR and TAVR utilization. Results: A total of 542,734 AVR procedures were analyzed. The utilization of SAVR was steady until 2014 with a significant downward trend in the following years 2015-2017 (P = 0.026). In contrast, a steady upward trend was observed in the TAVR procedure with a significant increase during the years 2015-2017 (P = 0.006). Higher in-hospital mortality was observed in SAVR patients. The mortality rate declined from 2011 to 2017 in a significantly higher proportion in the TAVR compared with the SAVR group. Conclusion: Utilization of SAVR showed a downward trend during the late TAVR era (2015-2017), and TAVR utilization demonstrated a steady upward trend during the years 2011-2017. Higher in-hospital mortality was recorded in patients who underwent SAVR.

Keywords: TAVR; aortic stenosis; aortic valve replacement; surgical aortic valve implantation; transcatheter and surgical aortic valve replacement; transcatheter aortic replacement.