Comparison of In-Hospital Outcomes of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Obese (Body Mass Index ≥ 30 Kg/M2) Patients

Abstract

The comparative outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in obese (body mass index ≥ 30 kg/m²) patients are underexplored. Nationwide Inpatient Sample database was queried from 2011 to 2014, and those who underwent TAVI or SAVR with obesity were identified. A complete case analysis with multivariate analysis was performed to adjust for the difference in underlying co-morbidities. We identified a total of 12,525 patients (989 TAVI and 11,536 SAVR). TAVI patients were elderly, more women, and had higher co-morbidity burden represented by a higher Deyo's modification of Charlson's score. Inpatient mortality was similar between the 2 groups (2.6% vs 3.2%, p = 0.21). TAVI patients had less hemorrhage requiring transfusion (8.5% vs 18%, p < 0.01), cardiac complication (7.3% vs 14%, p < 0.01), respiratory complication (1.3% vs 3.9%, p < 0.01), postop sepsis (1.0% vs 3.2%, p < 0.01), acute myocardial infarction (2.5% vs 5.5%, p < 0.01), acute kidney injury (18% vs 22%, p < 0.001), and nonroutine discharge (62% vs 67%, p < 0.001). Conversely, vascular complication (5.6% vs 4.5%, p = 0.04), new pacemaker (13% vs 5.4%, p < 0.001), and use of extracorporeal oxygen membrane (1.1% vs 0.3%, p = 0.002) were observed more frequently in TAVI patients. The median hospital cost was higher in TAVI ($50,957 vs $44,977, p = 0.004), whereas TAVI patients had a significantly shorter hospital stay (median 7.4 vs 10 days, p < 0.001). TAVI portended similar in-hospital mortality and less certain perioperative complications. In TAVI, the medical cost was higher, but the length of stay was shorter and nonroutine discharge was less frequent.