In-Hospital Mortality Trends and Association of Peripheral Artery Disease on Mortality Risk After Aortic Valve Replacements.

Introduction: Since 2011, transcatheter aortic valve replacement (TAVR) is an alternative to surgical valve replacement (SAVR). The objective was to describe predictors and trends of in-hospital mortality risk following SAVR and TAVR between 2011 and 2019. We also describe the underinvestigated association between peripheral artery disease (PAD) and mortality risk after TAVR.

Methods: Using a retrospective cohort from the National Inpatient Sample database, we identified operations with TAVR and SAVR as primary or secondary procedures and indication of aortic stenosis. The primary outcome was postoperative in-hospital morality. Sample-weighted logistic regression was used to examine the association between operation type and in-hospital mortality with interaction terms to describe change in mortality over time.

Results: Between 2011 and 2019, 129,305 patients were included: 82,583 (63.9%) SAVRs and 46,722 (36.1%) TAVRs. Influential predictors of mortality included age (odds ratio [OR] = 1.03 and p < 0.001), elective case status (OR = 0.55 and p < 0.001), and operation type (TAVR OR = 0.54 and p < 0.001). Procedure-related mortality risk changed significantly over time (p < 0.001). Initially (2011-2014), TAVR-associated mortality risk was higher than SAVR but this risk decreased substantially after 2014. PAD was not a significant predictor of in-hospital mortality among patients undergoing TAVR (OR = 0.98 and p = 0.91).

Conclusion: TAVR-related mortality risk was initially higher than SAVR-related mortality, but this risk substantially decreased to below SAVR levels in the later period of study. In this cohort study, PAD was not a significant predictor of in-hospital mortality after TAVR.