Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis.
Int J Cardiol Heart Vasc
; 42: 101119, 2022 Oct.
Article
en En
| MEDLINE
| ID: mdl-36161232
Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF. Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS). Results: A total of 74,995 octogenarian patients with HF (TAVR-HF n = 64,890 (86.5%); SAVR n = 10,105 (13.5%)) were included. The median age of patients in TAVR-HF and SAVR-HF was 86 (83-89) and 82 (81-84) respectively. TAVR-HF had lower percentage in-hospital mortality (1.8% vs. 6.9%;p < 0.001), CVA (2.5% vs. 3.6%; p = 0.009), SCA (9.9% vs. 20.2%; p < 0.001), AKI (17.4% vs. 40.8%); p < 0.001), major transfusion (26.4% vs 67.3%; p < 0.001), CS (1.8% vs 9.8%; p < 0.001), and MCS (0.8% vs 7.3%; p < 0.001) when compared to SAVR-HF. Additionally, post-procedural stroke and major bleeding showed no significant difference. The median unmatched total charges for TAVR-HF and SAVR-HF were 194,561$ and 246,100$ respectively. Conclusion: In this nationwide observational analysis, TAVR is associated with an improved safety profile for octogenarians with heart failure (both preserved and reduced ejection fraction) compared to SAVR.
AKI, Acute Kidney Injury; AS, Aortic Stenosis; CS, Cardiogenic Shock; CVA, Cerebrovascular Accident; CVD, cardiovascular disease; HF, Heart Failure; HFpEF, Heart Failure with a Preserved ejection fraction; HFrEF, Heart Failure with reduced Ejection fraction; Heart Failure with preserved ejection fraction; Heart Failure with reduced ejection fraction; Heart failure; LOS, Length of hospital stay; LVAD, Left ventricular assist device; MCS, Mechanical Circulatory Support; PSM, Propensity Matched; RCT, Randomized Controlled Trial; SAVR, Surgical aortic valve Replacement; SCA, sudden cardiac arrest; Surgical aortic valve replacement; TAVR, Transcatheter aortic valve replacement; Transcatheter aortic valve replacement
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Int J Cardiol Heart Vasc
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Irlanda