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Comparison of transcatheter to surgical aortic valve implantation in high risk patients : a nationwide study in France
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Armoiry, Xavier, Obadia, Jean-François, Pascal, Léa, Polazzi, Stéphanie and Duclos, Antoine (2018) Comparison of transcatheter to surgical aortic valve implantation in high risk patients : a nationwide study in France. The Journal of Thoracic and Cardiovascular Surgery, 156 (3). pp. 1017-1025. doi:10.1016/j.jtcvs.2018.02.092
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WRAP-Comparison-of-transcatheter-to-surgical-aortic-valve-Armoiry-2018.pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1019Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/j.jtcvs.2018.02.092
Abstract
Objective:
To compare the clinical outcomes and direct costs at 5 years between TAVI or SAVR using real-world evidence.
Methods:
We performed a nationwide longitudinal study using data from the French Hospital Information System over 2009-2015. We matched inside hospitals two cohorts of adults who underwent TAVI or SAVR in 2010 on propensity score based on patients characteristics. Outcomes analysis included mortality, morbidity, and total costs and with a maximum 60-month follow-up. Clinical outcomes were compared between cohorts using Hazard Ratios (HR) estimated from Cox proportional hazards model for all-cause death, and from Fine and Gray’s competing risk model for morbidity.
Results:
Based on a cohort of 1598 patients (799 in each group) from 27 centers, a higher risk of death was observed after 1 year with TAVI compared to SAVR (16.8% vs. 12.8% respectively; HR 1.33, 95%CI 1.02-1.72) and was sustained up to 5 years (52.4% vs. 37.2%; HR 1.56, 95%CI 1.33-1.84). At 5 years, the risk of stroke was increased (HR 1.64, 95%CI 1.07-2.54) as was myocardial infarction (HR 2.30, 95%CI 1.12-4.69) and pacemaker implantation (HR 2.40, 95%CI 1.81-3.17) after TAVI. The hospitalization costs per patient at 5 years were €69,083 after TAVI and €55,687 after SAVR (p<0.001).
Conclusions:
In our study, high-risk patients after TAVI harbor a greater risk of mortality and morbidity at 5 years compared to SAVR and higher hospitalizations costs. Those results should encourage to be more cautious before enlarging the indications of TAVI.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Aortic valve -- Stenosis -- Treatment -- France -- Case studies | ||||||||
| Journal or Publication Title: | The Journal of Thoracic and Cardiovascular Surgery | ||||||||
| Publisher: | Elsevier | ||||||||
| ISSN: | 0022-5223 | ||||||||
| Official Date: | 1 September 2018 | ||||||||
| Dates: |
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| Volume: | 156 | ||||||||
| Number: | 3 | ||||||||
| Page Range: | pp. 1017-1025 | ||||||||
| DOI: | 10.1016/j.jtcvs.2018.02.092 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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