Propensity matched comparison of in-hospital outcomes of TAVR vs. SAVR in patients with previous history of CABG: Insights from the Nationwide inpatient sample

Document Type

Article

Abstract

BACKGROUND: The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement (TAVR). METHODS: The Nationwide inpatient sample (NIS) from 2012 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥ 18 years with prior CABG who underwent TAVR (35.05 and 35.06) or SAVR (35.21 and 35.22). Propensity score matching (1:1) was performed and in-hospital outcomes were compared between matched cohorts. RESULTS: From 2012 to 2014, there was progressive increase in the annual number of TAVR procedures from 1485 to 4020, with a decrease in patients undergoing SAVR from 2330 to 1955 (P  < 0.0001) in the above population. There was no significant difference in in-hospital mortality rates. Compared to SAVR, TAVR was associated with lower risk of stroke (1.2% vs. 3.3%, P = 0.009), AKI (12.9% vs. 21.3%, P < 0.0001), myocardial infarction (0.9% vs. 2.7%, P = 0.01) and major bleeding (9.1% vs. 25.1%, P < 0.0001). TAVR was associated with higher risk of pacemaker implants (9.6% vs. 4.9%, P = 0.001) and trend toward lower risk of vascular complications (2.3% vs. 4.1%, P = 0.05). CONCLUSION: In this large cohort of patients with previous CABG, there is no significant difference in in-hospital mortality between TAVR and SAVR. TAVR was associated with lower risk of in-hospital outcomes.

Medical Subject Headings

Aged; Aged, 80 and over; Coronary Artery Bypass (adverse effects, mortality); Coronary Artery Disease (mortality, surgery); Databases, Factual; Female; Heart Valve Diseases (mortality, surgery); Heart Valve Prosthesis Implantation (adverse effects, mortality, trends); Hospital Mortality; Humans; Inpatients; Male; Postoperative Complications (mortality, therapy); Retrospective Studies; Risk Assessment; Risk Factors; Sternotomy (adverse effects, mortality, trends); Time Factors; Transcatheter Aortic Valve Replacement (adverse effects, mortality, trends); Treatment Outcome; United States (epidemiology)

Publication Date

12-1-2018

Publication Title

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

E-ISSN

1522-726X

Volume

92

Issue

7

First Page

1417

Last Page

1426

PubMed ID

30079611

Digital Object Identifier (DOI)

10.1002/ccd.27708

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