TAVI Linked to Fewer Complications Than SAVR in Pulmonary Hypertension

Transcatheter aortic valve implantation (TAVI) is associated with lower rates of cardiac, bleeding, and respiratory complications than surgical aortic valve replacement (SAVR) in people with pulmonary hypertension, according to a study recently published in the American Journal of Cardiology. The rate of in-hospital mortality was similar between the two methods.

This study included 36,786 individuals diagnosed with pulmonary hypertension and treated for aortic valve stenosis, 26% (n=9560) of whom underwent TAVI and 74% (n=27,225) of whom underwent SAVR. Compared with the SAVR group, participants who had TAVI were older (81.0 vs 68.5 years; P <.001), fewer were African American (4.6% vs 8.3%; P <.001), and more were women (53.2% vs 45.4%; P <.001).

All cases were sourced from the National Inpatient Sample database and were treated between 2011 and 2014. The study’s primary outcome was in-hospital mortality. Secondary outcomes included in-hospital hemorrhage and cardiac and respiratory complications, pacemaker implantation, acute kidney injury, and postoperative stroke.

Logistic regression was used to compare outcomes in the matched cohorts, with continuous variables compared using independent Student’s t-tests and Mann-Whitney U tests. Categorical variables were compared using the chi-squared test.

People who underwent TAVI had more congestive heart failure, renal failure, peripheral vascular disease, previous stroke, transient ischemic attacks, hyperlipidemia, coronary artery disease, and chronic pulmonary disease than those treated with SAVR (P ≤.002 for all). Hemorrhage requiring transfusion was less common among those with TAVI vs SAVR (10.8% vs 24.0%).

In-hospital mortality did not differ significantly between those treated with TAVI (5.6%) and SAVR (4.6%; odds ratio, 1.23 [95% CI, 0.92-1.66]; P =.165). Postoperative cardiac complications were less common among those who underwent TAVI (15.4%) compared with SAVR (19.9%; odds ratio, 0.73 [95% CI, 0.61-0.87]; P =.001), as were respiratory complications (12.4% vs 25.1%, respectively; odds ratio, 0.42 [95% CI, 0.35-0.51]; P <.001).

Study limitations included the retrospective observational design, potential selection bias, potentially inaccurate coding, a lack of data on the severity of pulmonary hypertension, and an inability to examine a dose response relation with pulmonary hypertension.

The researchers concluded that “patients with [pulmonary hypertension] and severe symptomatic [aortic stenosis] who underwent TAVI had comparable in-hospital mortality and lower cardiac complications, respiratory complications, and bleeding complications compared with patients who underwent SAVR.”

Reference

Al-Khadra Y, Darmoch F, Moussa Pacha H, et al. The outcomes of pulmonary hypertension patients with severe aortic stenosis who underwent surgical aortic valve replacement or transcatheter aortic valve implantation [published online May 25, 2019]. Am J Cardiol. doi: 10.1016/j.amjcard.2019.05.018

This article originally appeared on The Cardiology Advisor