Early post-approval experience with transcatheter aortic valve replacement in the USA

Transcatheter aortic valve replacement (TAVR) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TAVR versus surgical aortic valve repair (SAVR) in the real-world setting since USA TAVR approval in 2012.

The Nationwide Inpatient Sample (NIS) dataset was analyzed by quarter (June 2012 to December 2014). Patients (>65 years old) undergoing TAVR or SAVR were identified and risk stratified based on APR-DRG Mortality risk score. Outcomes were in-hospital mortality, length of stay (LOS), discharge location, and hospitalization cost.

TAVR cases per quarter increased from 1900 to 5445 over the study period. TAVR patients were older and had more comorbidities (P<0.001). TAVR patients had longer LOS (8 vs. 7 days; P<0.001), were less likely to discharge to home (67% vs. 73%; P<0.001), had higher inpatient mortality (5.5% vs. 0.69%; P<0.001) and overall hospital cost ($ 227,985 vs. $ 148,019; P<0.001) than SAVR patients. On multivariate analysis TAVR was associated with increased cost (β=0.42; P<0.001) and increased mortality (OR=5.228, CI: 3.508-7.791; P<0.001) but not associated with increased LOS (β=0.297; P=0.078) or discharge to facility (OR=1.004, CI: 0.833-1.213; P=0.960). In the last two quarters of 2014 there was no difference between TAVR and SAVR LOS, however TAVR cost did not decrease over the study period.

TAVR patients represented a sicker population, however LOS and discharge location outcomes were equivalent to SAVR. TAVR remained significantly more expensive across all risk groups and cost did not fall over the course of the study.