In-hospital outcomes of transapical versus surgical aortic valve replacement: from the U.S. national inpatient sample

OBJECTIVE To compare the outcomes of transapical transcatheter aortic valve replacement(TA-TAVR) and surgical aortic valve replacement(SAVR) using a large US population sample.METHODS The U.S. National Inpatient Sample was queried for all patients who underwent TA-TAVR or SAVR during the years2016-2017. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were in-hospital stroke, pericardiocentesis, pacemaker insertion, mechanical ventilation, vascular complications, major bleeding, acute kidney injury, length of stay,and cost of hospitalization. Outcomes were modeled using multi-variable logistic regression for binary outcomes and generalized linear models for continuous outcomes.RESULTS A total of 1 560 TA-TAVR and 44,280 SAVR patients were included. Patients who underwent TA-TAVR were older and frailer. Compared to SAVR, TA-TAVR correlated with a higher mortality(4.5% vs. 2.7%, effect size(SMD) = 0.1) and higher periprocedural complications. Following multivariable analysis, both TA-TAVR and SAVR had a similar adjusted risk for in-hospital mortality. TA-TAVR correlated with lower odds of bleeding with(adjusted OR(aOR) = 0.26; 95% CI: 0.18-0.38; P < 0.001), and a shorter length of stay(adjusted mean ratio(aMR) = 0.77; 95% CI: 0.69-0.84; P < 0.001), but higher cost(aMR = 1.18; 95% CI:1.10-1.28; P < 0.001). No significant differences in other study outcomes. In subgroup analysis, TA-TAVR in patients with chronic lung disease had higher odds for mortality(aOR = 3.11; 95%CI: 1.37-7.08; P = 0.007).CONCLUSION The risk-adjusted analysis showed that TA-TAVR has no advantage over SAVR except for patients with chronic lung disease where TA-TAVR has higher mortality.