Abstract
Objective
To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical
aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI).
Background
The treatment of choice for patients with severe symptomatic PAI is SAVR. However,
not all patients are candidates for surgery because of comorbidities or are deemed
high risk for surgery. As a result, TAVR is being used as an off-label procedure in
some patients with PAI.
Patients and Methods
We analyzed the National Inpatient Sample database from January 1, 2016, to December
31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion
criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR.
Patients with concomitant aortic stenosis, or history of infective endocarditis, and
those below the age of 18 years were excluded.
Results
A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent
TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P <.001). There was no evidence of a difference in in-hospital mortality between the
2 groups. However, after adjustment, patients in the TAVR group were associated with
favorable outcomes in terms of acute kidney injury, cardiogenic shock, postoperative
respiratory complications, and length of stay. On the other hand, those in the SAVR
group were less likely to need permanent pacemakers.
Conclusion
There was no evidence of a significant statistical difference in in-hospital mortality
between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched
cohorts. TAVR could be considered for patients with PAI who are not candidates for
surgery.
Abbreviations and Acronyms:
ICD (international classification of diseases), NIS (national inpatient sample), PAI (pure aortic insufficiency), PCI (percutaneous coronary intervention), SAVR (surgical aortic valve replacement), TAVR (transcatheter aortic valve replacement)To read this article in full you will need to make a payment
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Article Info
Footnotes
Grant Support: No grant support was provided for this article.
Potential Competing Interests: The authors report no competing interests.
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