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In-hospital outcomes mostly similar in younger patients undergoing TAVR, surgical AVR
Among patients aged younger than 75 years, most in-hospital outcomes did not differ among those who had transfemoral transcatheter aortic valve replacement and those who had surgical AVR, according to new findings.
According to the study background, most randomized trials of TAVR vs. surgical AVR have consisted primarily of patients aged 80 years or older, and less is known about in-hospital outcomes after AVR in younger patients.
Holger Eggebrecht, MD, from Cardioangiologisches Centrum Bethanien and AGAPLESION Bethanien Hospital, Frankfurt, Germany, and colleagues analyzed 6,972 patients aged 65 to 74 years who underwent transfemoral TAVR or surgical AVR between 2013 and 2014 and were included in the German Quality Assurance Registry on Aortic Valve Replacement.
The researchers analyzed in-hospital outcomes for the overall cohort and for 1,388 propensity-matched patients from the cohort.
Most of the cohort (82.4%) underwent surgical AVR. Patients who had TAVR were older, had more comorbidities and had a higher predicted risk for mortality than patients who had surgical AVR.
In the overall cohort, unadjusted in-hospital mortality rates were higher in the TAVR group (3.2% vs. 1.3%; P < .001), as were new pacemaker implants (14.2% vs. 2.9%; P < .001), while postoperative delirium was lower in the TAVR group (3.2% vs. 7%; P < .001) and there was no difference between the groups in neurologic events (TAVR, 1.9%; surgery, 1.6%; P = .56), according to the researchers.
In the propensity-matched cohort, however, there were no significant differences in in-hospital mortality (TAVR, 1.3%; surgery, 1.9%; P = .39), stroke/transient ischemic attack (TAVR, 1%; surgery, 2.1%; P = .09) and MI (TAVR, 0%; surgery, 0.3%; P = .16). The surgery group had greater incidence of postoperative delirium (2.4% vs. 8.9%; P < .001) and the TAVR group had greater need for pacemaker implantation (13.3% vs. 3.5%; P < .001).
“This propensity-matched analysis ... suggests similar in-hospital outcomes but less demanding recovery after TAVR,” Eggebrecht and colleagues wrote. “Further randomized studies are needed in younger patients to confirm these favorable in-hospital results during long-term course.” – by Erik Swain
Disclosure: The authors report no relevant financial disclosures.