Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison

J. Matthew Brennan, Laine Thomas, David J. Cohen, David Shahian, Alice Wang, Michael J. Mack, David R. Holmes, Fred H. Edwards, Naftali Z. Frankel, Suzanne J. Baron, John Carroll, Vinod Thourani, E. Murat Tuzcu, Suzanne V. Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-LakeFelicia L. Graham, Dadi Dai, Fan Li, Roland A. Matsouaka, Sean O'Brien, Fan Li, Michael J. Pencina, Eric D. Peterson

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)439-450
Number of pages12
JournalJournal of the American College of Cardiology
Volume70
Issue number4
DOIs
StatePublished - Jul 25 2017
Externally publishedYes

Keywords

  • outcomes
  • safety and effectiveness
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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