Impact of Peripheral Vascular Disease on Short-Term In-Hospital Outcomes in Patients Undergoing Surgical vs. Transcatheter Aortic Valve Replacement Procedures

Background
Transcatheter aortic valve replacement (TAVR) is an effective treatment option for patients with symptomatic valvular stenosis who are ineligible or at high risk for the traditional option of surgical aortic valve replacement (SAVR). Previous studies explored outcomes in SAVR and TAVR procedures. Peripheral vascular disease (PVD), a common comorbidity, has significant impact on decision making among patients undergoing aortic valve replacement for severe stenosis. This study aims to further compare SAVR vs. TAVR in patients with PVD.

Methods
This retrospective cohort study utilized data from the Nationwide Inpatient Sample to identify patients (18+) from 2012-2015 who underwent SAVR or TAVR. ICD-9 codes were used to identify patients with PVD and to exclude patients missing clinical identifiers (age, gender, death). Patients with aortic insufficiency, concomitant coronary artery bypass graft, mitral, tricuspid, pulmonic valve surgery, or atrial or ventricular septal defect closure were also excluded as combined surgery may affect outcomes. Data analyses assessed length of stay (LOS), total hospital charges, age of admission and mortality.

Results
Of the 47,501 patients who underwent SAVR or TAVR, 9,968 patients had a diagnosis of PVD. LOS was significantly increased for SAVR vs. TAVR (9.79 vs. 7.33 days, p<0.0001). Mortality was significantly increased for SAVR vs. TAVR (4.8% vs. 3.8%, p=0.022). Total hospital charges were significantly increased for SAVR vs. TAVR ($177,548.12 vs. $188,966.23, p=0.003). Mean age of admission was significantly increased for TAVR vs. SAVR (74.6 vs. 66.6 years, p<0.0001).

Conclusions
Patients who underwent SAVR with PVD suffer from increased LOS, mortality rate and total hospital charges accumulated. With significant decrease in LOS, mortality rate and total hospital charges in TAVR patients, the results of this study can aid clinicians in making important procedural decisions within this specific population. Limitations of this study include inability to determine severity of aortic stenosis or PVD in these patients. Peri-procedural optimization of symptomatic patients is one potential avenue to reduce LOS, total hospital charges, mortality rate and improve patient outcomes.