TAVR and SAVR Compared to Treat Patients With Aortic Stenosis and Cardiogenic Shock

May 2, 2024—A nationwide observational analysis of patients with aortic stenosis (AS) and cardiogenic shock (CS) who underwent transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) determined that patients who underwent TAVR had lower in-hospital complications and resource utilization compared with SAVR.

The retrospective cohort study used the National Inpatient Sample database to identify patients hospitalized for AS-CS from 2016 to 2020 who underwent isolated TAVR or SAVR. In-hospital outcomes of TAVR versus SAVR were compared using multivariable regression analysis. The study was led by Mahmoud Ismayl, MD, Cardiology Fellow and Assistant Professor at the Mayo Clinic in Rochester, Minnesota.

The results were presented at SCAI 2024, the Society for Cardiovascular Angiography & Interventions scientific sessions held May 2-4 in Long Beach, California.

According to the SCAI press release, there is little data on the use of TAVR versus SAVR for this high-risk patient population and the new data helps show the feasibility of TAVR, especially in patients who are already high-risk.

As summarized in the SCAI press release, the study was composed of 13,215 patients hospitalized for AS-CS, of whom 5,095 (38.6%) underwent isolated TAVR and 8,120 (61.4%) underwent isolated SAVR.

The factors independently associated with TAVR selection in AS-CS included age ≥ 65 years, female sex, renal failure, chronic pulmonary disease, previous coronary artery bypass grafting, and Impella heart pump support (Abiomed, part of Johnson & Johnson MedTech).

For SAVR, the factors independently associated with selection included Black race, Hispanic ethnicity, and peripheral vascular disease.

The investigators found that compared with SAVR, TAVR was associated with lower odds of stroke (adjusted odds ratio, 0.48), acute kidney injury, and major bleeding. In-hospital mortality, pacemaker placement, and vascular complications were similar between the two, while length of stay was shorter and total costs were lower with TAVR (both P < .01). The study also found that from 2016 through 2020, the use of TAVR increased, while the use of SAVR decreased in AS-CS (both P < .01).

“Results show that TAVR is a more feasible and safe option when compared to SAVR for some of the most high-risk patients who have AS and CS,” commented Dr. Ismayl in the SCAI press release. “We were initially able to see this in our clinical practice, so it is rewarding to share it with the cardiology community at this prestigious meeting. It is important that patients and cardiovascular professionals are aware of the benefits of the use of TAVR such as lower in-hospital complications and resource utilization because they are then able to advocate for the best treatment option.”

Further studies exploring the long-term comparative safety and effectiveness of TAVR compared to SAVR among patients with AS-CS are warranted, advised the investigators in the press release.