TY - JOUR
T1 - Transcatheter Versus Surgical Aortic Valve Replacement
T2 - Propensity-Matched Comparison
AU - Brennan, J. Matthew
AU - Thomas, Laine
AU - Cohen, David J.
AU - Shahian, David
AU - Wang, Alice
AU - Mack, Michael J.
AU - Holmes, David R.
AU - Edwards, Fred H.
AU - Frankel, Naftali Z.
AU - Baron, Suzanne J.
AU - Carroll, John
AU - Thourani, Vinod
AU - Tuzcu, E. Murat
AU - Arnold, Suzanne V.
AU - Cohn, Roberta
AU - Maser, Todd
AU - Schawe, Brenda
AU - Strong, Susan
AU - Stickfort, Allen
AU - Patrick-Lake, Elizabeth
AU - Graham, Felicia L.
AU - Dai, Dadi
AU - Li, Fan
AU - Matsouaka, Roland A.
AU - O'Brien, Sean
AU - Li, Fan
AU - Pencina, Michael J.
AU - Peterson, Eric D.
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/7/25
Y1 - 2017/7/25
N2 - 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.
AB - 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.
KW - outcomes
KW - safety and effectiveness
KW - surgical aortic valve replacement
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jacc.2017.05.060
DO - 10.1016/j.jacc.2017.05.060
M3 - Article
C2 - 28728688
AN - SCOPUS:85028585146
SN - 0735-1097
VL - 70
SP - 439
EP - 450
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -