Impact of transcatheter aortic valve implantation on surgical aortic valve.

Introduction And Objectives: TAVR is thought to change the volumes, characteristics, and outcomes of patients with aortic stenosis undergoing SAVR. We sought to investigate the impact of increasing transcatheter aortic valve replacement (TAVR) volumes on surgical aortic valve replacement (SAVR) volumes and to assess the evolution in baseline demographics and its impact on 30-day clinical outcomes across TAVR and SAVR patients.

Methods: From June 2007 through September 2015, 3543 consecutive patients with severe aortic stenosis who underwent TAVR (n=1407) or SAVR (n=2136) in a single center were subcategorized into nine cohorts defined by procedure year. These cohorts were examined for differences in volumes, baseline demographics, and 30-day mortality.

Results: We observed a reduction in SAVR compared to TAVR volumes over time: from 79% in 2007 to 48% in 2015 (P<0.001). The mean STS score of the TAVR patients decreased significantly from 6.8 in 2007 to 4.3 in 2015 (P<0.001). Concurrently, the crude 30-day mortality for TAVR improved from 11% in 2007 to 3% in 2015 (P<0.001). The overall 30-day mortality was similar between TAVR and SAVR after adjusting for the independent predictors of mortality (adjusted odds ratio (OR)=0.758; P=0.2).

Conclusions: In a high-volume surgical center, we observed a significant decrease in patients undergoing SAVR compared to TAVR. We show an important shift toward the selection of lower surgical risk patients for TAVR. Overall 30-day mortality was similar between TAVR and SAVR after adjusting for baseline characteristics.