Impact of Coagulation Disorders 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. Coagulation disorders have 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 pre-disposed with coagulation disorders.

Methods
This retrospective cohort study utilized 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 coagulation disorders and to exclude patients missing 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 charges, age of admission and mortality.

Results
Of the 47,501 who underwent SAVR or TAVR, 12,886 patients had a diagnosis of a coagulation disorder. LOS was significantly increased for SAVR vs. TAVR (10.1 vs. 8.21 days, p<0.0001). Mortality was significantly increased for SAVR vs. TAVR (6.2% vs. 5.1%, p=0.032). Total charges were significantly increased for TAVR vs. SAVR ($205,418.64 vs. $195,977.51, p=0.036). Age of admission was significantly increased for TAVR vs. SAVR (75.6 vs. 68.9 years, p<0.0001).

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