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Comparison of transcatheter versus 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 versus 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 ISSN 1097-685X.
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Official URL: https://doi.org/10.1016/j.jtcvs.2018.02.092
Abstract
Objective
To compare the clinical outcomes and direct costs at 5 years between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) using real-world evidence.
Methods
We performed a nationwide longitudinal study using data from the French Hospital Information System from 2009 to 2015. We matched, inside hospitals, 2 cohorts of adults who underwent TAVI or SAVR during 2010 on propensity score based on patient 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 (HRs) estimated from a 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 with SAVR (16.8% vs 12.8%, respectively; HR, 1.33; 95% confidence interval [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 < .001).
Conclusions
In our study, high-risk patients harbored a greater risk of mortality and morbidity at 5 years after TAVI compared with those who underwent SAVR and higher hospitalizations costs. Those results should encourage caution before expanding the indications of TAVI.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Aortic valve -- Surgery -- Cost effectiveness -- France, Aortic valve -- Stenosis -- Cost effectiveness -- France | ||||||||
| Journal or Publication Title: | The Journal of Thoracic and Cardiovascular Surgery | ||||||||
| Publisher: | Elsevier | ||||||||
| ISSN: | 1097-685X | ||||||||
| 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 | ||||||||
| Date of first compliant deposit: | 5 June 2018 | ||||||||
| Date of first compliant Open Access: | 7 April 2019 |
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