The TAVR vs SAVR competition continues, and James Edelman, MD, offered more data to consider.
Periprocedural complications may be associated with increased mortality and cost after transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. However, it has hitherto been unknown whether the impact of such complications on outcomes differs by treatment strategy, according to James Edelman, MD, who presented a study of these factors based upon the results of the PARTNER 2A randomized trial.
Senior author Vinod Thourani, MD, and Dr. Edelman, both of MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, and their colleagues assessed data from intermediate risk (IR) patients who randomized to TAVR or SAVR in the PARTNER 2A trial in order to estimate the independent association between six major complications and in-hospital and 2-year mortality, and in-hospital costs. The six complications examined were: perioperative myocardial infarction [MI], disabling stroke, major vascular complication, acute kidney injury [AKI] Stage II, AKI Stage III, and respiratory failure.
The researchers used a Cox Proportional Hazards model to determine mortality associations, and multiple linear regression was used to assess cost associations. Treatment-by-complication interaction terms were included in each model to determine treatment differences, added Dr. Edelman.
The study assessed 1,938 patients: 994 who underwent TAVR, and 944 who underwent SAVR. A major complication occurred in 547 patients (28.2%): 334 SAVR patients (35.3%) and 213 TAVR patients (21.4%). The investigators found that major vascular complications and AKI III increased the risk of in-hospital mortality similarly for both TAVR and SAVR. In addition, disabling stroke, AKI stage II, and respiratory failure significantly increased the risk of mortality at 2 years with similar impact among patients undergoing either TAVR or SAVR.
There was significantly higher hospital mortality with AKI II in TAVR vs. SAVR and the impact of AKI Stage III was significantly greater in TAVR than SAVR.
Both disabling stroke and AKI Stage III increased in-hospital cost similarly with TAVR and SAVR while major vascular complications and AKI stage II each significantly increased cost only with TAVR. Postoperative respiratory failure resulted in increased costs for both TAVR and SAVR, but the magnitude of this increase was only significantly greater with SAVR than with TAVR, Dr. Edelman stated.