OR07-8
Transcatheter Aortic Valve Replacement (TAVR) vs Surgical Aortic Valve Replacement (SAVR) in Patients with Liver Cirrhosis- Nationwide Readmission Analysis
Presenter
Shafaqat Ali, MD, Ochsner LSU Health Shreveport, Shreveport, LA
Manoj Kumar1, Sanchit Duhan, MBBS2, Shafaqat Ali, MD3, Sanjay Kumar4 and Michael Sewell3, (1)John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, (2)LifeBridge Health - Sinai Hospital, Baltimore, MD, (3)Ochsner LSU Health Shreveport, Shreveport, LA, (4)Icahn School of Medicine at Mount Sinai, Jamaica, NY
Keywords: TAVI/TAVR/Aortic Valve
Background
Cirrhotic patients undergoing cardiac surgery have a high risk of complications and death. This study aims to evaluate the outcomes of TAVR compared to SAVR in this population. Methods
The national readmission database (2016-2020) was used to identify patients undergoing TAVI or SAVR for aortic valve replacement. Mahalanobis Distance Matching was utilized for propensity matching. Pearson’s x2 test was applied to the matched cohorts to compare outcomes. Results
Among 14,764 propensity-matched hospitalizations for aortic valve replacement in liver cirrhosis, 7,109 underwent TAVR, and 7,655 underwent SAVR. SAVR had higher median LOS (16 vs. 3 days) and total cost ($500,218 vs $263,383) in index admission and in subsequent 30 to 180-day readmissions [p<0.001]. Major adverse cardiovascular events (43.5 vs. 24.3%) were higher in the SAVR group at 30- & 180-day readmissions [p<0.001]; however, acute HF was more frequent with TAVR (56.9 vs. 34.7%, p<0.001). TAVR was also associated with higher readmission rates at 30- (11.1% vs 9%) and 180 days (39.8% vs. 33.4%) [p<0.05]. From 2016-2020, median LOS (5 to 3 days) and total cost ($72,818 to $65,124) has decreased in TAVR but continued to increase in SAVR (median LOS: 15 to 17 days and cost: $116,039 to $130,367) [p-trend: <0.001] Conclusions
In liver cirrhosis, SAVR was associated with higher resource utilization and adverse outcomes on the readmission analysis. Although this cohort had lower rates of acute HF exacerbations and readmission rates. 