Author + information
- Jasmine D. Patel1,
- Kevin L. Ong1,
- Edmund Lau2,
- Michael P. Savage3,
- David L. Fischman3 and
- Nicholas Ruggiero3
Transcatheter aortic valve replacements (TAVR) were indicated for the treatment of severe, symptomatic aortic stenosis in inoperable patients in 2011 and high risk, operable patients in 2012. The purpose was to examine the performance of TAVR in comparison to surgical aortic valves (SAVR) in a nationally representative population.
Patients were identified from the 5% Medicare data (1997-2014 for SAVRs and 2011-2014 for TAVRs). Post-operative rates of mortality, mechanical complications, infection, valve re-implantation were evaluated in patients aged 80+. Medicare payments for surgical hospitalization ($June 2015) were assessed.
The following number of valve procedures were identified: 17,413 tissue valves, 10,781 mechanical valves, and 1,377 TAVR. Over 67% of the patients implanted with surgical valves were aged 65-79, whereas 74% of TAVR patients were over 80 years old. The adjusted 10-year mortality, complication, infection and revision risks projected for patients aged 80+ using a multivariate Cox model are presented in the table below. Of note is the significantly high risk of re-implantation for TAVR. Average Medicare payments for patients aged 80+ implanted with tissue valves and TAVRs were $63.1k and $53.1k, respectively.
After adjusting for sex, morbidity level, and other factors, the risk of mortality, complications, and reoperation were higher for TAVRs in comparison to SAVRs, but not significantly in all cases. As TAVR becomes more commonplace in the moderate and low risk groups, a comparison of the long-term outcomes in a nationally representative population will be necessary to assess their safety and efficacy.
|Device||Mortality (Hazard Ratio#)||Mechanical Complication (Hazard Ratio#)||Infection (Hazard Ratio#)||Re-implantation/ Reoperation rates (Hazard Ratio#)|
|TAVR||88.9% (1.48, 1.28-1.71)*||9.3% (2.68, 1.29-5.58)||3.7% (0.64, 0.31-1.34)||2.9% (8.52, 2.12-34.17)*|
# Relative to tissue valves