TAVR linked to lower risk of in-hospital mortality than SAVR
Transcatheter aortic valve replacement (TAVR) is associated with a significantly lower in-hospital mortality rate than surgical aortic valve replacement (SAVR), according to new findings published in The American Journal of Cardiology.[1] Once patients were home from the hospital, however, mortality rates were similar for the two treatment techniques.
“While landmark clinical trials and recent registry studies have established the overall safety and non-inferiority of TAVR compared to SAVR in various risk groups, a critical gap persists in understanding differential in-hospital mortality across specific comorbidity-defined subgroups and complex risk phenotypes,” wrote senior author Akash Sharma, MBBS, a researcher with University of Arkansas for Medical Sciences, and colleagues. “Randomized controlled trials often exclude or underrepresent patients with advanced systemic multi-organ illnesses, severe renal dysfunction, active malignancies or complex baseline vulnerabilities.”
Sharma et al. explored the Nationwide Readmission Database (NRD), tracking data from more than 350,000 patients who underwent TAVR or SAVR from 2016 to 2020. While approximately 50.5% of patients underwent TAVR, the remaining patients underwent SAVR.
Overall, the in-hospital mortality rates were 1.4% for TAVR and 3.7% for SAVR. The authors performed a multivariate logistic regression and confirmed that SAVR was associated with a higher in-hospital mortality risk than TAVR. Once patients had been discharged, meanwhile, mortality rates after 30 days, three months and six months were comparable for the two treatment techniques.
The group also used advanced artificial intelligence to determine that hyperlipidemia, liver failure and kidney failure were all associated with an increased risk of in-hospital mortality.
“Notably, interaction terms such as liver failure × SAVR and kidney failure × SAVR were among the most impactful variables, suggesting that the predictive value of SAVR may be significantly modified in the presence of hepatic or renal dysfunction,” the authors wrote.
In addition, the group found that women were more likely to be rehospitalized after TAVR or SAVR than men. Congestive heart failure, atrial fibrillation (AFib), hyperlipidemia and diabetes were also associated with a heightened risk of cardiac rehospitalization following aortic valve replacement.
“The practical clinical implication of this study is that the choice between TAVR and SAVR should be driven by a lifetime and comorbidity-specific risk framework,” the authors wrote. “In older patients, patients with limited life expectancy, or those with hepatic dysfunction, renal failure, heart failure, AFib, transcatheter therapy may offer a meaningful early safety advantage. Conversely, SAVR remains important for patients in whom anatomy, age, expected longevity, valve durability, or concomitant cardiac disease favor surgery. SAVR may be preferable in younger patients with a long life expectancy, patients requiring concomitant CABG or aortic surgery, and selected patients with bicuspid or other anatomies that are less suitable for TAVR. Current guidelines specifically emphasize age, life expectancy, anatomy, durability, and shared decision-making rather than procedure selection based on age or comorbidity alone.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.