With the rapid expansion of indications for transcatheter aortic valve replacement (TAVR) for patients with lower surgical risks, more patients requiring aortic valve replacement (AVR) are considered for transcatheter aortic valve replacement ( TAVR), not surgical AVR (SAVR). However, with the introduction of new equipment, it is not clear how the implementation of TAVR will change the overall pattern of AVR in the United States.

A new study led by Yale University, published in the Journal of the American College of Cardiology on November 22, answers basic questions about the characteristics and outcomes of traditional and minimally invasive treatment options for older people who require aortic valve replacement.

The results show that in the past ten years, TAVR has expanded by 680%, and the survival rate, readmission rate and transfer to emergency facilities of patients undergoing aortic valve replacement have steadily increased. A 60% increase in all AVRs (SAVR or TAVR) indicates that with the advent of this new technology, the accessibility of treatment has improved.

In this study, a research team led by Harlan M. Krumholz, MD, Harold H. Hines, Jr. Professor of Medicine and Director of the Center for Outcome Research and Evaluation (CORE) analyzed medical insurance data and identified more than 400,000 hospitalized patients Over 65 years of age who underwent TAVR or surgery between 2012 and 2019.

The data shows that the results of AVR have improved overall. It is worth noting that the 30-day mortality rate of AVR decreased from 4.4% to 2.7%, and the 1-year mortality rate also decreased from 11.6% to 9.4%. Overall, the 30-day readmission rate for surgery and TAVR increased from 18.5% to 13.6%. In addition, the average hospital stay for TAVR was reduced from 6 days to 2 days, and the average hospital stay for SAVR was reduced from 8 days to 7 days. The average length of hospital stay for AVR has also been reduced by 5 days.

SAVR has been available since the 1960s. However, for many patients with severe aortic valve stenosis, TAVR is a minimally invasive catheter-based intervention that has become a new complementary therapy.

“We report that the rapid increase in TAVR implementation does not seem to worsen the results of SAVR in patients who need to replace the aortic valve. SAVR is a supplement to TAVR,” said Makoto Mori, MD and resident of cardiothoracic surgery. The core and first author of the research.

"SAVR has been in use for decades, but it is not clear how the emergence of new TAVR technology has changed the overall pattern of treatment methods and outcomes in this patient population. The overall improvement in the results of the overall patient group receiving SAVR or TAVR is a relief Trend," Krumholz said.

Other authors at Yale University include Oyere Onuma and Arnar Geirsson. Co-authors include Aakriti Gupta of Cedars-Sinai, Yun Wang of Harvard Medical School, Torsten Vahl, Tamim Nazif, Isaac George, and Ajay Kirtane of Columbia University, and Celina Yong of Stanford University School of Medicine.