Abstract 8247: National Trends and In-Hospital Outcomes of TAVR+PCI Versus SAVR+CABG in Aortic Stenosis: Impact of the Low-Risk TAVR Era

Abstract

Background: Transcatheter Aortic Valve Replacement (TAVR) is a less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for the treatment of aortic stenosis (AS). Following FDA approval for low-risk patients in 2019 and incorporation into the 2020 valvular heart disease guidelines, utilization of TAVR has expanded. Coronary artery evaluation is a standard component of pre-procedural assessment for both TAVR and SAVR, and concomitant coronary artery disease (CAD) often necessitates Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG), respectively. Methods: Using ICD-10 codes, we queried the Nationwide Inpatient Sample (NIS) database from 2016-2023 to identify hospitalizations for AS undergoing either TAVR+PCI or SAVR+CABG. The primary outcome was in-hospital mortality, while secondary outcomes included complications and resource utilization measures. Outcomes were also compared between the pre- and post-2020 eras following expansion of TAVR to low-risk patients. Survey-weighted (SVY) analysis was performed for national estimates, and propensity score matching (PSM) analysis was used to reduce selection bias. Results: A total of 15,944 unweighted hospitalizations met inclusion criteria, including 12,184 (76.4%) undergoing SAVR + CABG and 3,760 (23.6%) undergoing TAVR + PCI. Utilization of TAVR+PCI increased from 15.9% in 2016 to 30.8% in 2023, particularly in the post-2020 era, while SAVR+CABG utilization declined from 84.1% in 2016 to 69.2% in 2023. In SVY analysis, TAVR+PCI was associated with lower in-hospital mortality compared with SAVR+CABG (aOR 0.44, 95% CI 0.32-0.60, p<0.001). TAVR+PCI was additionally associated with lower odds of acute kidney injury (aOR 0.34), PRBC transfusion (aOR 0.21), mechanical ventilation (MV) (aOR 0.37), vasopressor use (aOR 0.28), and facility discharge (aOR 0.16), along with significantly shorter length of stay (LOS) (aGMR 0.46) and lower total hospitalization charges (TOTCHG) (aGMR 0.96) (all p<0.05). Stroke and cardiac arrest were similar between groups. However, TAVR+PCI was associated with greater odds of permanent pacemaker implantation (aOR 1.52, 95% CI 1.27-1.82, p<0.001). Findings remained consistent following PSM analysis, which included 15,261 hospitalizations. Era-based interaction analysis demonstrated consistent treatment effects over time, with significant interaction observed for MV, LOS, and TOTCHG. Conclusions: TAVR+PCI was associated with lower in-hospital mortality, fewer peri-procedural complications, shorter LOS, and more favorable discharge disposition compared with SAVR+CABG. Following expansion of TAVR to low-risk patients, utilization of transcatheter strategies increased substantially. These findings support the growing role of less invasive transcatheter approaches in appropriately selected patients with AS and concomitant CAD.