ISSN 1671-5411 CN 11-5329/R
Volume 18 Issue 9
Sep.  2021
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Please cite this article as: Abugroun A, Hallak O, Taha A, Sanchez-Nadales A, Awadalla S, Daoud H, Igbinomwanhia E, Klein LW. In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample. J Geriatr Cardiol 2021; 18(9): 702−710. DOI: 10.11909/j.issn.1671-5411.2021.09.005
Citation: Please cite this article as: Abugroun A, Hallak O, Taha A, Sanchez-Nadales A, Awadalla S, Daoud H, Igbinomwanhia E, Klein LW. In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample. J Geriatr Cardiol 2021; 18(9): 702−710. DOI: 10.11909/j.issn.1671-5411.2021.09.005

In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

doi: 10.11909/j.issn.1671-5411.2021.09.005
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  • Corresponding author: aabugroun@mcw.edu
  • Available Online: 2021-08-20
  • Publish Date: 2021-09-30
  •  OBJECTIVE  To compare the outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) and surgical aortic valve replacement (SAVR) using a large US population sample.  METHODS  The U.S. National Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the years 2016−2017. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital stroke, pericardiocentesis, pacemaker insertion, mechanical ventilation, vascular complications, major bleeding, acute kidney injury, length of stay, and cost of hospitalization. Outcomes were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous outcomes.  RESULTS  A total of 1560 TA-TAVR and 44,280 SAVR patients were included. Patients who underwent TA-TAVR were older and frailer. Compared to SAVR, TA-TAVR correlated with a higher mortality (4.5% vs. 2.7%, effect size (SMD) = 0.1) and higher periprocedural complications. Following multivariable analysis, both TA-TAVR and SAVR had a similar adjusted risk for in-hospital mortality. TA-TAVR correlated with lower odds of bleeding with (adjusted OR (aOR) = 0.26; 95% CI: 0.18−0.38; P < 0.001), and a shorter length of stay (adjusted mean ratio (aMR) = 0.77; 95% CI: 0.69−0.84; P < 0.001), but higher cost (aMR = 1.18; 95% CI: 1.10−1.28; P < 0.001). No significant differences in other study outcomes. In subgroup analysis, TA-TAVR in patients with chronic lung disease had higher odds for mortality (aOR = 3.11; 95%CI: 1.37−7.08; P = 0.007).  CONCLUSION  The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.
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