The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Interventions for valvular disease and heart failure

The changing landscape of aortic valve replacement in the USA

EuroIntervention 2019;15:e968-e974. DOI: 10.4244/EIJ-D-19-00381

1. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; 2. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 3. Columbia University Medical Center, New York, NY, USA; 4. Vanderbilt University Medical Center, Nashville, TN, USA; 5. Henry Ford Health System, Detroit, MI, USA; 6. Cleveland Clinic Foundation, Cleveland, OH, USA; 7. Rhode Island Hospital, Brown University, Providence, RI, USA; 8. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; 9. Mayo Clinic, Rochester, MN, USA; 10. Cardiovascular Research Foundation, New York, NY, USA; 11. Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA

Aims: The aim of this study was to analyse the real-world national data on parallel utilisation of transcatheter (TAVR) and surgical (SAVR) aortic valve replacement.

Methods and results: We queried an all-payer, administrative United States in-patient database to identify all AVR hospitalisations in patients aged ≥18 years from January 2012 to December 2016 and examined the temporal changes in the number of AVR procedures and in-hospital mortality. A total of 463,675 AVRs were performed – 363,275 (78.4%) SAVR and 100,400 (21.6%) TAVR. AVR linearly increased (from 78,985 in 2012 to 103,415 in 2016; +30.9%; ptrend<0.001) largely due to a marked increase in TAVR (from 7,655 to 33,545; +338%; ptrend<0.001), whereas the absolute number of SAVRs remained relatively stable (from 71,330 to 69,870; –1%; ptrend<0.001). The number of TAVRs increased in all pre-specified age groups (<75, 75-79, 80-85, and ≥85 years; ptrend<0.001 for all). In contrast, the number of SAVRs increased modestly in patients aged <75 years (ptrend<0.001) and declined in those aged 75-79 years, 80-84 years, or ≥85 years (ptrend<0.001 for all). Age- and sex-adjusted in-hospital mortality after isolated (aOR 1.00 [0.95-1.05]; ptrend=0.96) or combined SAVR (aOR 1.01 [0.97-1.05]; ptrend=0.66) remained unchanged during the study period, whereas in-hospital mortality after TAVR declined (aOR 0.75 [0.70-0.79]; ptrend<0.001). Similar trends in in-hospital mortality were seen in the age subgroups.

Conclusions: The number of AVRs markedly increased in the USA from 2012 to 2016, mainly due to the widespread adoption of TAVR, whereas the number of SAVRs remained relatively stable. In-hospital mortality after TAVR declined, whereas that after SAVR has remained unchanged.

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