Trends in Complications among Patients undergoing Aortic Valve Replacement (AVR) in the United States

ABSTRACT Background The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in in-hospital complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated. Methods We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries aged ≥65 years treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study endpoint was the occurrence of a major complication during the index AVR hospitalization, defined as a composite outcome. Multivariable logistic regression was used to assess odds of complications for TAVR and SAVR, individually over time, after adjusting for baseline characteristics. Another risk-adjusted model assessed the risk of complications for TAVR vs SAVR, over time. Results The cohort included 211,212 patients (mean age:78.6±7.3 years, female:45.0%). Complication rates following elective isolated AVR decreased from 49% in 2012 to 22% in 2019. These reductions were more pronounced for TAVR (41%->19%, delta=22%) than SAVR (51%->47%, delta=4%). After risk adjustment, the risk of any complication with TAVR was 47% (p<0.0001) lower compared to SAVR in 2012, and 78% (p<0.0001) lower in 2019. TAVR was independently associated with reduced odds of complications each year compared to 2012, with the magnitude of benefit increasing over time (2013 vs 2012: OR=0.89(0.81-0.97); 2019 vs 2012: OR=0.35(0.33-0.38)). Conclusions Between 2012-2019, the risk of complications after AVR among Medicare beneficiaries decreased significantly, with larger absolute and relative changes among patients treated with TAVR than SAVR.