Transcatheter Aortic Valve Replacement shows lower complication and pacemaker rates with similar outcomes and cost when compared to Rapid Deployment Edwards Intuity Valve in patients undergoing aortic valve replacement.

Abdel-Aal Ahmed, Mohamed

Transcatheter Aortic Valve Replacement shows lower complication and pacemaker rates with similar outcomes and cost when compared to Rapid Deployment Edwards Intuity Valve in patients undergoing aortic valve replacement.

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Mohamed Abdel-Aal Ahmed, MD , University at Buffalo The State University of New York, Buffalo, NY

Yan Yatsynovich, MD , University at Buffalo The State University of New York, Buffalo, NY

Tharmathai Thammi Ramanan, M.D. , University at Buffalo The State University of New York, Orchard Park, NY

Brian Conway, MD , University at Buffalo The State University of New York, Buffalo, NY

Abhinay Reddy, MD , University at Buffalo The State University of New York, Buffalo, NY

Nikhil Agrawal, MD , State University Of New York At Buffalo, Buffalo, NY

Ashutosh Sharma, MD , University at Buffalo The State University of New York, Buffalo, NY

Rosemary Hansen, DNP , Great Lakes Cardiovascular, Buffalo, NY

Gerald Colern, NP , Great Lakes Cardiovascular, Buffalo, NY

Vijay S. Iyer, M.D., Ph.D., FSCAI , Great Lakes Cardiovascular, East Amherst, NY

Background
In the era of balloon inflatable aortic valves, Transcatheter Aortic Valve Replacement (TAVR) is a rapidly growing and evolving alternative to surgical aortic valve replacement (SAVR). We compared TAVR against the surgical balloon-expandable rapid deployment Edwards Intuity valve in terms of outcomes and overall hospitalization costs.

Methods
We retrospectively evaluated 79 patients who underwent SAVR with Intuity valve (Edwards Lifesciences) and 168 patients who underwent TAVR at our institution in 2018. Clinical, procedural and cost data was gathered and analyzed.

Results
A total of 94% of patients had successful TAVR with moderate sedation, despite higher risk scores and more comorbid conditions (Figure 1). The ICU length of stay in the TAVR group was 0.49+/-0.8 days vs 4.5+/-4.5 days for the SAVR group (p=0.00). The total length of stay in the TAVR group was 2.8+/-3.4 days vs 8.5+/-6 days in the SAVR group (p=0.00). The cost of the hospitalization for the TAVR group was $45,316+/-9,232 vs $45,450+/-17,516 for the SAVR group (p=0.94). There was a trend towards increasing cost in the SAVR group with increasing age compared to a more uniform cost for the TAVR group (Figure 2). The rate of pacemaker implantation in the TAVR group was 10% vs 21.5% in the SAVR group (0.012). Major bleeding requiring transfusion occurred in 8.3% of the TAVR group vs 11.5% of the SAVR group (p=0.44). Acute kidney injury (AKI) was noted in 4.2% of the TAVR group vs 13.2% of the SAVR group (0.014) (Figure 3).

Conclusions
TAVR was associated with shorter length of stay, lower pacemaker rates, and lower incidence of AKI when compared to the Intuity SAVR cohort at a similar cost.