Propensity-Matched Comparison Evaluates Safety and Effectiveness of TAVR Versus SAVR

July 17, 2017—Findings from a propensity-matched comparison of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) were published by J. Matthew Brennan, MD, et al in Journal of the American College of Cardiology (2017;70:439–450). The aim of this study was to determine the safety and effectiveness of TAVR versus SAVR, particularly in intermediate- and high-risk patients, in a nationally representative real-world cohort.

The investigators concluded that among unselected intermediate- and high-risk patients, TAVR and SAVR resulted in similar rates of death, stroke, and days alive and out of the hospital to 1 year, but TAVR patients were more likely to be discharged home.

In the study, data were used from the Transcatheter Valve Therapy Registry and Society of Thoracic Surgeons (STS) National Database linked to Medicare administrative claims for follow-up. They examined 9,464 propensity-matched intermediate- and high-risk (STS Predicted Risk of Mortality score, ≥ 3%) United States patients who underwent commercial TAVR or SAVR. Death, stroke, and days alive and out of the hospital to 1 year were compared, as well as discharge home, with subgroup analyses by surgical risk, demographics, and comorbidities.

As summarized in Journal of the American College of Cardiology, in a propensity-matched cohort (median age, 82 years; 48% women; median STS Predicted Risk of Mortality score, 5.6%), TAVR and SAVR patients experienced no difference in 1-year rates of death (17.3% vs 17.9%; hazard ratio, 0.93; 95% confidence interval [CI], 0.83–1.04) and stroke (4.2% vs 3.3%; hazard ratio, 1.18; 95% CI, 0.95–1.47), and no difference was observed in the proportion of days alive and out of the hospital to 1 year (rate ratio, 1; 95% CI, 0.98–1.02). However, TAVR patients were more likely to be discharged home after treatment (69.9% vs 41.2%; odds ratio, 3.19; 95% CI, 2.84–3.58). Results were consistent across most subgroups, including among intermediate- and high-risk patients, reported the investigators in Journal of the American College of Cardiology.