Outcome and Cost Comparisons Between Surgical and Transcatheter Aortic Valve Replacements

Area of Science:

• Cardiology
• Cardiac Surgery
• Health Economics

Background:

• Severe aortic stenosis management traditionally relies on surgical aortic valve replacement (SAVR).
• Transcatheter aortic valve replacement (TAVR) has emerged as a viable alternative, with implantations surpassing SAVR in 2019.
• Comparative cost and outcome analyses are crucial for guiding clinical decision-making.

Purpose of the Study:

• To compare the in-hospital costs and clinical outcomes of TAVR versus SAVR for severe aortic stenosis.
• To identify differences in resource utilization and patient outcomes between the two procedures.

Main Methods:

• A single-center retrospective review of patients undergoing isolated SAVR or TAVR between October 2013 and December 2019.
• Collection of baseline characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS), total LOS, cumulative cost, and complication rates.
• Propensity score matching to create comparable patient cohorts for analysis.

Main Results:

• Propensity matching yielded 82 pairs. TAVR patients had shorter ICU LOS, total LOS, and OR times.
• SAVR was associated with higher hospitalization costs, while TAVR had higher mean OR and valve costs.
• TAVR showed less postoperative atrial fibrillation but more pacemaker placements. One-year mortality was similar, but SAVR had better 3- and 5-year survival.

Conclusions:

• TAVR is linked to reduced ICU and hospital LOS and shorter OR times compared to SAVR.
• SAVR demonstrates significantly improved long-term survival rates at 3 and 5 years post-procedure.
• While TAVR offers short-term benefits, SAVR remains superior for long-term survival in severe aortic stenosis.