Trends in Isolated Surgical Aortic Valve Replacement According to Hospital-Based Transcatheter Aortic Valve Replacement Volumes

Why this study – the rationale/objective

This study compared the volumes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) since the approval of TAVR in the United States. The Medicare Provider Analysis and Review (MEDPAR) database was used to extract volumes for 2011-2014. The volume of SAVR decreased in hospitals with the largest number of TAVR procedures. At the same time, 30-day and 1-year mortality after SAVR declined in the hospitals with the largest TAVR volumes. Patients who underwent SAVR showed a decrease in comorbidities over time. The study provides some interesting insights. First, the large number of excluded centers highlight the large amount of centers in the US that perform very few aortic valve procedures. Second, the lower mortality after SAVR and low risk profile of SAVR patients was likely the result of high risk patients getting TAVR. Third, the current study does not include data from recent years. It will be very interesting to learn whether the increasing TAVR volume leads to a decrease in SAVR volume, especially since results of TAVR vs. SAVR in low risk patients are expected shortly.