Temporal Trends in Utilization of Transcatheter and Surgical Aortic Valve Stenosis Therapies in Heart Failure Patients

Al-khadra, Yasser

Temporal Trends in Utilization of Transcatheter and Surgical Aortic Valve Stenosis Therapies in Heart Failure Patients

Monday, May 20, 2019

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

Yasser Al-khadra, M.D. , Cleveland Clinic Foundation, Cleveland, OH

Fahed Darmoch, M.D. , St. Vincent charity medical center , Boston, MA

Homam Moussa Pacha , Medstar Institute, Washington Hospital Center, Washington, DC

Mohamad Soud, M.D. , Washingtom Hospital Center, Washigton, DC

Amir Kaki, M.D., FSCAI, FSCAI , Lenox Hill Hospital, Birmingham, MI

M. Chadi Alraies, M.D. , Detroit Medical Center Heart Hospital, Detroit, MI

Background
Heart failure (HF) is a common comorbidity in patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Limited information is available on the temporal trends of TAVR or SAVR use and outcomes in HF patients.

Methods
Using NIS database from 2011-14, we identified all patients who underwent TAVR or SAVR and were diagnosed with HF. Temporal trends in the utilization of TAVR or SAVR in HF patient were analyzed.

Results
Among 27,982 patients who were diagnosed with HF, 9,049 (32.3%) underwent TAVR and 16,933 (76.7%) underwent SAVR. 17,681 (63.2%) had heart failure with preserved ejection fraction (HFpEF) and 10,301 (36.8%) had heart failure with reduced ejection fraction (HFrEF). HFrEF patients had increased utilization for TAVR and SAVR (ptrend< 0.001) and similarly for HFpEF patients (ptrend< 0.001). This increase in utilization was associated with decreased mortality in TAVR group over the years [2.8% in 2012 to 1.8% in 2014 (p 0.013)]. Multivariate logistic regression showed a statistically significant lower in-hospital mortality in the TAVR group compare with SAVR (aOR 0.634; CI 0.504, 0.798, P < 0.001).

Conclusions
With increased utilization of TAVR for patients with severe AS, outcome of HF patients undergoing TAVR improved due to improved technology, operator experience and patient optimization prior to procedure.