Transcatheter Versus Surgical Aortic Valve Replacement in the United States (From the Nationwide Readmission Database)

Am J Cardiol. 2021 Jun 1:148:110-115. doi: 10.1016/j.amjcard.2021.02.031. Epub 2021 Mar 3.


Clinical outcomes of transcatheter aortic valve implantation (TAVI) have significantly improved with the accumulation of operator and institution experience as well as the wide use of newer generation devices. There is limited data on TAVI outcomes compared with surgical aortic valve replacement (SAVR) in contemporary practice in the United States. We queried the 2018 Nationwide Readmission Database of the United States. International Classification Diagnosis code 10 was used to extract TAVI and SAVR admissions. A propensity-matched cohort was created to compare TAVI and SAVR outcomes. A weighted 48,349 TAVI and 24,896 SAVR for aortic stenosis were included and 4.9% of TAVI were performed with an embolic protection device. In propensity-matched cohort (12,708 TAVI and 12,708 SAVR), TAVI conferred lower in-hospital mortality (1.7% vs 3.8%), acute kidney injury (11.3% vs 22.9%), and transfusion rate (5.9% vs. 20.6%) whereas new pacemaker rate was higher in TAVI compared with SAVR (10.5% vs. 7.0%) (all p values < 0.001). Stroke rate was similar between TAVI and SAVR (1.5% vs. 1.5%) (p value = 0.79). The routine discharge was more frequent (66.9% vs 25.8%) and length of stay was shorter (4.8 vs. 9.8 days) in TAVI than SAVR. Hospitalization cost was higher in SAVR than TAVI (51,962 vs 57,754 U.S. dollars) (all p values < 0.001). In-hospital mortality was also lower in TAVI compared with isolated SAVR. TAVI was performed more frequently than SAVR in 2018 in the United States with lower in-hospital mortality of TAVI compared with both SAVR and isolated SAVR.

Publication types

  • Comparative Study

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / surgery*
  • Arrhythmias, Cardiac / epidemiology*
  • Arrhythmias, Cardiac / therapy
  • Blood Transfusion / statistics & numerical data*
  • Cardiac Pacing, Artificial
  • Female
  • Heart Valve Prosthesis Implantation
  • Hospital Costs / statistics & numerical data
  • Hospital Mortality*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Pacemaker, Artificial
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / therapy
  • Propensity Score
  • Stroke / epidemiology
  • Transcatheter Aortic Valve Replacement*
  • United States / epidemiology