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Transcatheter and Surgical Aortic Valve Replacement Outcomes for Patients with Chronic Heart Failure

Talha Mubashir1, Julius Balogh1, Rabail Chaudhry2

  • 1Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX.

Journal of Cardiothoracic and Vascular Anesthesia
|July 29, 2020
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) shows similar in-hospital mortality to surgical aortic valve replacement (SAVR) in chronic heart failure patients. TAVR offers reduced complications, shorter stays, and lower costs, suggesting it may be a safer option.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Aortic stenosis (AS) and chronic heart failure (CHF) represent significant comorbidities.
  • Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are primary treatment options for symptomatic AS.
  • Comparative outcomes between TAVR and SAVR in CHF patients require further investigation.

Purpose of the Study:

  • To compare in-hospital outcomes of TAVR versus SAVR in patients with concomitant CHF and AS.
  • To identify high-risk patient groups associated with adverse outcomes in both TAVR and SAVR procedures.
  • To evaluate the safety and efficacy of TAVR as an alternative to SAVR in this complex patient population.

Main Methods:

  • Retrospective analysis of the Nationwide Inpatient Sample database (January 2012–September 2015).
  • Inclusion of adult patients diagnosed with both CHF and AS who underwent either TAVR or SAVR.
  • Comparison of in-hospital mortality, postoperative complications, length of stay, and total costs between the two intervention groups.

Main Results:

  • A total of 5,871 TAVR and 4,008 SAVR procedures were analyzed.
  • TAVR patients were older, more frequently female, and presented with a higher comorbidity burden.
  • No significant difference in in-hospital mortality was observed; however, SAVR was associated with a longer length of stay (3.5 days longer) and higher total costs. Postoperative complications, excluding complete heart block, permanent pacemaker implantation, and vascular complications, were more frequent in the SAVR group. Multivariate analysis identified age ≥75 years and vascular complications as mortality predictors for TAVR, while cardiac, respiratory, and renal complications predicted mortality in both groups.

Conclusions:

  • TAVR demonstrates comparable in-hospital mortality to SAVR in CHF patients with symptomatic AS, despite a higher comorbidity burden.
  • TAVR is associated with a lower risk of major postoperative complications and potentially reduced hospital stay and costs.
  • TAVR may represent a safer and more cost-effective treatment option for patients with CHF and symptomatic AS.
Abstract

Keywords:
Chronic heart failuresurgical aortic valve replacementtranscatheter aortic valve replacement

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