Treating patients with transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) is associated with a lower in-hospital mortality rate and fewer major bleeding events than surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG), according to a new retrospective study published in the American Journal of Cardiology.
On the other hand, the combination of TAVR and PCI was also associated with more vascular complications and higher hospitalization costs.
The research team’s analysis included data from more than 31,000 patients with aortic stenosis (AS) or coronary artery disease (CAD) who underwent TAVR + PCI or SAVR + CABG. While more than 2,000 patients underwent TAVR + PCI, more than 29,000 patients underwent SAVR + CABG. All patients received care in 2016 and 2017, and researchers took their information from a database of U.S. community hospitals.
Overall, patients who received TAVR + PCI experienced lower rates of mortality, major bleeding events, acute kidney injury, sepsis and non-home discharge. Post-procedure infections were also less common among these patients.
“The increased risk for infection seen with surgery is linked to multiple factors including surgical incision, and perioperative blood transfusion, together with the use of central venous lines and urinary catheter placement,” wrote lead author Ashraf Abugroun, MD, Medical College of Wisconsin in Wauwatosa, and colleagues.
Digging deeper, Abugroun et al. noted that vascular complications, pericardiocentesis and the need for pacemaker insertion were all more common among patients treated with TAVR + PCI.
“The reported incidence of vascular complications following TAVR has ranged from 1.9% to 30.7%,” the authors wrote. “Despite the adoption of wide innovative technologies and the use of lower-profile delivery systems, the risk for vascular complications remains higher in TAVR than in SAVR. This is in accordance with the current data. In contrast, a major bleeding event requiring blood transfusion was higher following SAVR with CABG.”
As the authors expected, SAVR + CABG was associated with a longer length of stay. The hospitalization cost was higher, however, when the patient was treated with TAVR + PCI.
The risk of stroke was not significantly different between the two cohorts.
The team’s full analysis is available here.