Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Aortic Stenosis and Cardiogenic Shock
Author Department
Cardiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
9-2024
Abstract
Background: Patients with aortic stenosis (AS) and cardiogenic shock (CS) are an extremely high-risk population with a poor prognosis in the absence of definitive therapy.
Aims: To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical AVR (SAVR) in patients with AS-CS.
Methods: We queried the Nationwide Readmission Database (2016-2021) to identify patients hospitalized for AS-CS who underwent isolated TAVR or SAVR. In-hospital outcomes of TAVR vs SAVR were compared using multivariable regression and propensity-matching analyses. Ninety-day readmissions were compared using Cox proportional hazards regression model.
Results: Of 16,072 patients hospitalized for AS-CS, 6,381 (39.7%) underwent isolated TAVR, and 9,691 (60.3%) underwent isolated SAVR. From 2016 through 2021, the proportion of TAVR increased from 29.5% to 46.5% and the proportion of SAVR correspondingly decreased in AS-CS (ptrend<0.01). After adjustment for baseline characteristics, TAVR was associated with lower odds of stroke (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.44-0.79), acute kidney injury (aOR 0.79, 95% CI 0.68-0.92), and major bleeding (aOR 0.54, 95% CI 0.40-0.72) and higher odds of vascular complications (aOR 1.55, 95% CI 1.22-1.96) compared with SAVR. In-hospital mortality, myocardial infarction, permanent pacemaker placement, and 90-day all-cause and heart failure readmissions were similar. Length of stay was shorter and total costs and nonhome discharges were lower with TAVR.
Conclusions: This nationwide observational analysis showed that TAVR is increasingly performed in patients with AS-CS and is associated with similar in-hospital mortality and 90-day readmissions, but lower in-hospital complications and resource utilization compared with SAVR.
Keywords: Aortic Stenosis; Cardiogenic Shock; In-Hospital Mortality; Outcomes; SAVR; TAVR.
Recommended Citation
Ismayl M, Ahmed H, Goldsweig AM, Eleid MF, Guerrero M, Rihal CS. Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Aortic Stenosis and Cardiogenic Shock. Eur Heart J Acute Cardiovasc Care. 2024 Sep 12:zuae103. doi: 10.1093/ehjacc/zuae103. Epub ahead of print.
PMID
39268865