Transcatheter Versus Surgical Aortic Valve Replacement: Propensity-Matched Comparison

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Services Research

Background:

• Randomized trials indicate transcatheter aortic valve replacement (TAVR) efficacy in high- and intermediate-risk aortic stenosis patients.
• Generalizability of trial results to real-world clinical practice remains a concern.

Purpose of the Study:

• To assess the safety and effectiveness of TAVR compared to surgical aortic valve replacement (SAVR).
• Focus on intermediate- and high-risk patients within a nationally representative real-world cohort.

Main Methods:

• Utilized linked data from the Transcatheter Valve Therapy Registry, Society of Thoracic Surgeons National Database, and Medicare claims.
• Examined 9,464 propensity-matched intermediate- and high-risk patients undergoing commercial TAVR or SAVR.
• Compared 1-year outcomes including death, stroke, days alive out of hospital, and discharge destination.

Main Results:

• No significant difference in 1-year mortality (17.3% TAVR vs. 17.9% SAVR) or stroke rates (4.2% TAVR vs. 3.3% SAVR) between TAVR and SAVR.
• Identical proportion of days alive and out of hospital to 1 year for both procedures.
• TAVR patients were significantly more likely to be discharged home (69.9% vs. 41.2%).

Conclusions:

• In unselected intermediate- and high-risk patients, TAVR and SAVR demonstrate comparable 1-year rates of death, stroke, and days alive out of hospital.
• TAVR is associated with a higher likelihood of home discharge post-procedure.