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TAVR and SAVR Mortality in New York AS Patients
Study Questions:
What are the changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR), and what are the relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting in New York?
Methods:
New York’s Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk.
Results:
The total number of AVR patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135, and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR], 1.30; 95% confidence interval [CI], 0.89-1.92). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR, 1.42; 95% CI, 0.68-2.97) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR, 1.27; 95% CI, 0.81-1.98).
Conclusions:
The authors concluded that TAVR has assumed a much larger share of all AVRs for severe aortic stenosis, and the average level of preprocedural risk has decreased substantially.
Perspective:
This study reports that in a relatively short period of time, TAVR has become a very popular alternative for treating high-risk patients with severe aortic stenosis. Furthermore, there was no significant overall difference in mortality between TAVR and SAVR in high- or medium-risk patients in this study. Given the observational nature of this study, the results of clinical trials (e.g., PARTNER II and SURTAVI) that are currently underway to compare TAVR and SAVR outcomes will provide additional insight into safety and efficacy of this new technology for medium-risk patients.
Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Heart Valve Diseases, Heart Valve Prosthesis, Mortality, New York, Outcome Assessment, Health Care, Risk Factors, Surgical Procedures, Operative, Transcatheter Aortic Valve Replacement
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