In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians

Abstract

Background Octogenarians have low physiologic reserve and may benefit more from transcatheter aortic valve replacement ( TAVR ) than surgical aortic valve replacement ( SAVR ). Methods and Results This retrospective cohort study based on the National Inpatient Sample included octogenarians who underwent TAVR or SAVR from 2012 to 2015. Crude and standardized‐morbidity‐ratio‐weighted regression models were used to compare in‐hospital outcomes. Among 19 145 TAVR and 9815 SAVR hospitalizations, TAVR patients had higher Charlson Comorbidity Index ( CCI ) scores (2.0 versus 0.8, P <0.0001) than SAVR patients. Before weighting, TAVR was associated with significantly shorter length of stay, more home discharges, and lower incidences of acute kidney injury, bleeding, and cardiogenic shock. Associations were consistent across Charlson Comorbidity Index, except for TAVR being associated with greater length of stay reductions among patients with Charlson Comorbidity Index ≥2, compared with Charlson Comorbidity Index <2 (change in estimate −3.56 versus −2.61 days, P =0.004). After weighting, TAVR patients had significantly shorter length of stay (change in estimate −3.29 days, 95% CI −3.82, −2.75) and lower odds of transfer to skilled nursing facility (odds ratio 0.34, 95% CI 0.29, 0.41), acute kidney injury (odds ratio 0.55, 95% CI 0.45, 0.68), bleeding (odds ratio 0.44, 95% CI 0.37, 0.53), and cardiogenic shock (odds ratio 0.55, 95% CI 0.33, 0.92), compared with SAVR patients. Odds of permanent pacemaker implantation, transient ischemic attack/stroke, vascular complications, and in‐hospital mortality were not significantly different. Conclusions TAVR may be preferred over SAVR in high‐risk octogenarians because of shorter length of stay, better discharge disposition, and less acute kidney injury, and bleeding. All octogenarians may benefit more from TAVR , irrespective of comorbidity burden, but additional research is needed to confirm our findings.

The influence of integrated geriatric outpatient clinics on the health care utilization of older people

“…A subgroup analysis with the CCI classification was performed to evaluate the efficacy of integrated outpatient clinics for the oldest population and for high comorbidity patients (CCI ≥ 2). A CCI score greater than 2 or 3 was defined as a high comorbidity score and is related to high mortality [18][19][20][21][22].…”

Pacemaker implantation after balloon- or self-expandable transcatheter aortic valve replacement in patients with aortic stenosis

“…Targeting shorter hospital stay may play a role in these results, favoring more frequent and earlier PPI, and avoiding a too long ECG monitoring. [12][13][14] It has also been reported that delayed atrioventricular block may be an underappreciated complication of TAVR among patients without preprocedure pacing devices, 15 and this may lead to a more aggressive approach at a nationwide level. Predictors for PPI at the acute phase post TAVR and on a longer term were broadly similar to those previously reported by others in far smaller series, particularly for older age and right bundle branch block.…”

The influence of integrated geriatric outpatient clinics on the health care utility of older people

“…A subgroup analysis with the CCI classi cation was performed to evaluate the e cacy of integrated outpatient clinics for the oldest population and for high comorbidity patients (CCI≥2). A CCI score greater than 2 or 3 was de ned as a high comorbidity score and is related to high mortality [18][19][20][21][22].…”