Transcatheter vs surgical aortic valve replacement in patients with end stage renal disease
Catheterization and Cardiovascular Interventions Jul 28, 2020
Khan MZ, Khan MU, Kalra A, et al. - Using the National‐Inpatient‐Sample, researchers sought to ascertain contemporary national trends of comorbidities, outcomes, and healthcare resource utilization in patients with aortic stenosis (AS) and end‐stage renal disease (ESRD) undergoing transcatheter and surgical aortic valve replacement (TAVR and SAVR). From January 2012 to December 2017, they identified 12,550 patients for inclusion this study; of these, 5,735 underwent TAVR and 6,815 underwent SAVR. Over the years, they observed decrease in the utilization of SAVR (from 82.0 to 37.7%); and increase in the utilization of TAVR (from 18.0 to 62.3%). Although higher comorbidity burden (anemia, coronary artery disease, chronic pulmonary disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease) was observed among patients undergoing TAVR, there were lower inpatient mortality and complications (ST‐elevation myocardial infarction, pneumonia, pneumothorax, pulmonary embolism, cardiogenic shock, cardiac arrest, and need for mechanical ventilators and vasopressors). Further, patients with TAVR had reduction in the median length of stay (13.9–6.5 days) and cost of stay ($311,538.16 to $255,693.40); but for those with SAVR, these remained unchanged. Patients were discharged home in higher proportion after TAVR vs SAVR.
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