Original Investigation
Trends in Transcatheter and Surgical Aortic Valve Replacement Among Older Adults in the United States

https://doi.org/10.1016/j.jacc.2021.09.855Get rights and content
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Abstract

Background

Recent trends, including survival beyond 30 days, in aortic valve replacement (AVR) following the expansion of indications for transcatheter aortic valve replacement (TAVR) are not well-understood.

Objectives

The authors sought to characterize the trends in characteristics and outcomes of patients undergoing AVR.

Methods

The authors analyzed Medicare beneficiaries who underwent TAVR and SAVR in 2012 to 2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. Cox proportional hazard models were used to assess the annual change in outcomes.

Results

Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95% CI: 0.92-0.94) for TAVR and 0.98 (95% CI: 0.97-0.99) for SAVR, and 0.94 (95% CI: 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR.

Conclusions

The advent of TAVR has led to about a 60% increase in overall AVR in older adults. Improving outcomes in AVR as a whole following the advent of TAVR with increased access is a reassuring trend.

Key Words

discharge depositions
older adults
surgical aortic valve replacement
transcatheter aortic valve replacement
trend

Abbreviations and Acronyms

AVR
aortic valve replacement
CMS
Centers for Medicare & Medicaid Services
FFS
fee-for-service
SAVR
surgical aortic valve replacement
TAVR
transcatheter aortic valve replacement

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs Mori and Gupta contributed equally to this work.