TAVR was associated with lower in-hospital all-cause mortality than SAVR in patients with aortic stenosis and a pre-existing pacemaker or ICD (0.80% vs 2.59%; OR 0.31; 95% CI 0.10-0.94; P=0.049).
Observational (n=8,776)
Yes
Does TAVR reduce in-hospital mortality and complications compared to SAVR in adults with severe aortic stenosis and a pre-existing permanent pacemaker or ICD?
In patients with severe aortic stenosis and pre-existing cardiac rhythm devices, TAVR is associated with significantly lower in-hospital mortality and fewer periprocedural complications compared to SAVR.
Odds Ratio: 0.31 (95% CI 0.1–0.94)
Absolute Event Rate: 0.8% vs 2.59%
p-value: p=0.049
Patients with severe aortic stenosis and a pre-existing permanent pacemaker (PPM) or implantable cardioverter-defibrillator represent a distinct subgroup in whom the usual pacemaker disadvantage of transcatheter aortic valve replacement (TAVR) is largely neutralized. We used the National Inpatient Sample 2016-2022 to compare isolated TAVR versus surgical aortic valve replacement (SAVR) in adults with aortic stenosis and pre-existing PPM/implantable cardioverter-defibrillator. After exclusions, 8776 hospitalizations were identified (8141 TAVR; 635 SAVR), and 501 well-balanced propensity-matched pairs were formed. The primary outcome was in-hospital all-cause mortality; secondary outcomes included major adverse cardiovascular and cerebrovascular events, procedural complications, length of stay, and discharge disposition. In the matched cohort, in-hospital mortality was lower after TAVR than SAVR (0.80% vs 2.59%; matched odds ratio 0.31, 95% confidence interval, 0.10-0.94; P = 0.049). TAVR was also associated with a lower major adverse cardiovascular and cerebrovascular events, stroke/transient ischemic attack, acute kidney injury, major bleeding/transfusion, cardiogenic shock, respiratory failure, lead revision, nonroutine discharge, and shorter length of stay, without excess new-pacemaker procedures. These findings support TAVR as a favorable strategy in selected patients already carrying cardiac rhythm devices.
Abomohsen et al. (Mon,) conducted a observational in Severe aortic stenosis with pre-existing permanent pacemaker or implantable cardioverter-defibrillator (n=8,776). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on In-hospital all-cause mortality (OR 0.31, 95% CI 0.10-0.94, p=0.049). TAVR was associated with lower in-hospital all-cause mortality than SAVR in patients with aortic stenosis and a pre-existing pacemaker or ICD (0.80% vs 2.59%; OR 0.31; 95% CI 0.10-0.94; P=0.049).