CHANGES IN OUTCOMES OVER TIME IN INTERMEDIATE-RISK PATIENTS TREATED FOR
SEVERE AORTIC STENOSIS
Abstract
Background:The advent of TAVR changed the practice for treating patients
with severe aortic stenosis. Heart-Teams improved their decision-making
process to refer patients to the best and safest treatment. Evidence
allowed centers to increase funding and TAVR volume and extend
indications to different risk category of patients. This study evaluates
the outcomes of intermediate-risk patients treated for severe aortic
stenosis in an academic center. Methods:Between 2012 and 2019, 812
patients with aortic stenosis underwent TAVR or SAVR. A propensity
score-matching analytic strategy was used to balance groups and adjust
for time periods. Outcomes were recorded according to the Society of
Thoracic Surgeons Guidelines; primary outcome being 30-day mortality and
secondary outcomes being perioperative course and complications.
Results:No difference in mortality was seen but complications differed:
more postoperative transient ischemic attacks, permanent pacemaker
implantations and perivalvular leaks in the transcatheter group, while
more acute kidney injuries, atrial fibrillation, delirium, postoperative
infections and bleeding, tamponade and need for reoperation in the
surgical group as well as longer hospital length-of-stay. However, over
the years, morbidities/mortality decreased for all patients treated for
aortic stenosis. Conclusions:Data showed an improvement in
morbidities/mortality for intermediate risk patients treated with SAVR
or TAVR. Increased funding allowed for higher TAVR volume by increasing
access to this technology. Also, the difference in complications could
impact healthcare cost. By incorporating important metrics such as
length-of-stay, readmission rates and complications into
decision-making, the Heart-Team can improve clinical outcomes,
healthcare economics and resource utilization.