Ando T, et al. – This study compared the outcomes between obese (body mass index ≥ 30 kg/m²) patients who underwent transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Findings demonstrated that TAVI portended similar in–hospital mortality and less certain perioperative complications, although incurred a higher medical cost and offered a shorter length of stay and less frequent nonroutine discharge.

Methods

• Researchers queried Nationwide Inpatient Sample database from 2011 to 2014 to identify patients who underwent TAVI or SAVR with obesity.
• They performed a complete case analysis with multivariate analysis to adjust for the difference in underlying co-morbidities.

Results

• They identified a total of 12,525 patients (989 TAVI and 11,536 SAVR).
• Data reported that TAVI patients were elderly, more women, and had higher co-morbidity burden represented by a higher Deyo's modification of Charlson's score.
• Researchers observed that inpatient mortality was similar between the 2 groups (2.6% vs 3.2%, p = 0.21).
• They also noted that TAVI patients had less hemorrhage requiring transfusion (8.5% vs 18%, p < 0.01), cardiac complication (7.3% vs 14%, p < 0.01), respiratory complication (1.3% vs 3.9%, p < 0.01), postop sepsis (1.0% vs 3.2%, p < 0.01), acute myocardial infarction (2.5% vs 5.5%, p < 0.01), acute kidney injury (18% vs 22%, p < 0.001), and nonroutine discharge (62% vs 67%, p < 0.001).
• Conversely, vascular complication (5.6% vs 4.5%, p = 0.04), new pacemaker (13% vs 5.4%, p < 0.001), and use of extracorporeal oxygen membrane (1.1% vs 0.3%, p = 0.002) were observed more frequently in TAVI patients.
• In addition, findings demonstrated that the median hospital cost was higher in TAVI ($50,957 vs $44,977, p = 0.004), whereas TAVI patients had a significantly shorter hospital stay (median 7.4 vs 10 days, p < 0.001).