Impact of Transcatheter Aortic Valve Replacement on Risk Profiles of Surgical Aortic Valve Replacement Patients
Paige Craig, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Toby Rogers, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
Quan Zou, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Rebecca Torguson, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Petros G. Okubagzi, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Afshin Ehsan, Division of Cardiothoracic Surgery, The Miriam Hospital, Providence, RI, United States of America.
John Goncalves, Cardiac Surgery Program, The Valley Hospital, Ridgewood, NJ, United States of America.
Chiwon Hahn, Department of Cardiothoracic Surgery, Henrico Doctors' Hospital, Richmond, VA, United States of America.
Thomas Bilfinger, Department of Surgery, Stony Brook Hospital, Stony Brook, NY, United States of America.
Scott Buchanan, Cardiovascular Service Line, Maine Medical Center, Portland, ME, United States of America.
Robert Garrett, St. John Clinic Cardiovascular Surgery, St. John Heart Institute Cardiovascular Consultants, St. John Health System, Tulsa, OK, United States of America.
Vinod H. Thourani, Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America.
Paul Corso, Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America.
Christian Shults, Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America.
Ron Waksman, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America. Electronic address: ron.waksman@medstar.net.
Abstract
BACKGROUND: The advent of transcatheter aortic valve replacement (TAVR) has changed which patients undergo surgical aortic valve replacement (SAVR). We sought to understand the impact of TAVR on the characteristics of SAVR patients in the United States. METHODS: A cohort of 2959 patients who underwent isolated SAVR at 11 US hospitals that perform both TAVR and SAVR from 2013 through 2017 were grouped by the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database version (v)2.73 (2011-2014), v2.81 (2014-2017), and v2.9 (2017) to assess temporal trends in patient characteristics. RESULTS: Over time, SAVR patients were younger with fewer preoperative comorbidities. There was a significant decrease in median STS predicted risk of mortality (PROM) score (2.0 vs. 1.8 vs. 1.3, p < 0.001, in v2.73 vs. v2.81 vs. v2.9). Specifically, there were fewer high-risk (STS PROM > 8%: 4.3% vs. 4.7% vs. 1.2%, p = 0.03) and intermediate-risk (STS PROM 4% to 8%: 16.3% vs. 11.7% vs. 4.3%, p < 0.001) patients. The proportion of patients with bicuspid aortic valve disease increased significantly (11.2% vs. 26.9% vs. 36.6%, p < 0.001). There were no differences in operative mortality (1.9% vs. 2.1% vs. 1.4%, p = 0.75). CONCLUSIONS: The introduction of TAVR has already impacted the demographics, clinical characteristics and risk profiles of patients undergoing SAVR in the US. Now that TAVR is approved for low-risk patients, SAVR is likely to be reserved for younger patients who are willing to receive a mechanical valve and for patients with aortopathy, coronary artery disease, or concomitant mitral or tricuspid pathology.
