Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Rheumatoid Arthritis (from the Nationwide Inpatient Database)

Abstract

Little is known on the outcomes of surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI) in patients with rheumatoid arthritis (RA). We queried the Nationwide Inpatient Sample Database (2012 to 2016). We performed a propensity-score-matched analysis based on 25 clinical and hospital variables to compare patients with RA who underwent SAVR versus TAVI. Our primary outcome was in-hospital mortality. Our final analysis included 5,640 hospitalizations with RA who underwent isolated AVR; of whom, 2,465 (43.7%) underwent TAVI. There was an increasing trend in TAVI procedures during the study years (p_trend= 0.001). There was a trend toward reduced in-hospital mortality among TAVI compared with SAVR but did not reach statistical significance (0.8% vs 1.6%, odds ratio = 0.50; 95% confidence interval 0.23 to 1.06, p = 0.097). TAVI was associated with lower rates of postoperative bleeding (28.7% vs 43.9%, p <0.001), blood transfusion (12.3% vs 40.2%, p <0.001), acute kidney injury (9.8% vs 16.0%, p <0.001), cardiac tamponade (0.0% vs 1.6%, p <0.001), and discharges to skilled nursing facility (SNF) (20.1% vs 42.2%, p <0.001). However, TAVI was associated with a higher rate of complete heart block (14.3% vs 6.1%, p <0.001) and pacemaker implantations (14.8% vs 5.7%, p <0.001). There were no differences between both groups in cardiogenic shock, acute stroke, acute myocardial infarction, and vascular complications. In conclusion, real-word data showed no significant difference in in-hospital mortality between TAVI and SAVR in patients with RA. TAVI was associated with lower rates of acute kidney injury and bleeding complications at the expense of higher incidence of pacemaker implantations.