Transcatheter Versus Surgical Aortic Valve Replacement in Hypertrophic Cardiomyopathy Patients with Aortic Stenosis

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Mohammed Mhanna1, Abdul Mannan Khan Minhas2, Robert W Ariss3

  • 1Department of Internal Medicine, The University of Toledo, Toledo, OH.

Current Problems in Cardiology
|March 28, 2022
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) shows lower in-hospital mortality and fewer complications than surgical aortic valve replacement (SAVR) in hypertrophic cardiomyopathy patients with severe aortic stenosis. Further research on long-term outcomes is needed.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Severe aortic stenosis (AS) is treated with surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).
  • Patients with hypertrophic cardiomyopathy (HCM) were excluded from key TAVR trials, limiting comparative data.
  • Understanding TAVR vs. SAVR outcomes in HCM patients with AS is crucial.

Purpose of the Study:

  • To compare in-hospital outcomes and resource utilization between TAVR and SAVR in adult patients with HCM and severe AS.
  • To evaluate the safety and efficacy of TAVR versus SAVR in this specific patient population.

Main Methods:

  • Analysis of the 2016-2019 National Inpatient Sample database.
  • Identification of adult hospitalizations with HCM undergoing SAVR or TAVR for severe AS.
  • Comparison of primary (in-hospital mortality) and secondary outcomes, including complications and resource utilization.

Main Results:

  • TAVR was associated with lower in-hospital mortality compared to SAVR in HCM patients with AS.
  • TAVR demonstrated reduced rates of bleeding requiring transfusion, acute kidney injury, and shorter hospital stays.
  • No significant differences were observed in cardiac arrest, new permanent pacemaker, or cardiac tamponade rates between TAVR and SAVR.

Conclusions:

  • Transcatheter aortic valve replacement (TAVR) offers a lower-risk alternative to surgical aortic valve replacement (SAVR) for hypertrophic cardiomyopathy patients with isolated severe aortic stenosis.
  • TAVR is linked to decreased in-hospital mortality, fewer peri-procedural complications, and improved resource utilization.
  • Further investigation into the long-term efficacy and safety of TAVR versus SAVR in this cohort is warranted.

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