Abstract Body:
Background: Aortic stenosis is associated with substantial morbidity and mortality if left untreated. Surgical aortic valve replacement (SAVR) has long been the standard treatment, but transcatheter aortic valve replacement (TAVR) has expanded rapidly across surgical risk groups. We evaluated national trends, treatment selection, and in-hospital outcomes of TAVR versus SAVR in contemporary U.S. practice.
Methods: We performed a retrospective study using the National Inpatient Sample from 2016–2022. Adult hospitalizations with a diagnosis of aortic stenosis undergoing TAVR or SAVR were identified using ICD-10 procedure codes. Analyses incorporated survey weights, hospital clustering, and sampling strata to generate nationally representative estimates. Multivariable survey-weighted regression models were used to evaluate determinants of treatment selection and associations with in-hospital outcomes. Propensity-adjusted analyses were performed to account for differences in baseline patient and hospital characteristics between treatment groups.
Results: Annual weighted aortic stenosis hospitalizations ranged from approximately 365,000 to 412,000 during the study period. TAVR utilization increased from 7.4% of hospitalizations in 2016 to 16.4% in 2022, whereas SAVR declined from 9.5% to 4.3%. TAVR surpassed SAVR as the predominant valve replacement modality beginning in 2017 and remained the dominant approach through 2022. Increasing age, greater comorbidity burden, and treatment at urban teaching hospitals were associated with higher likelihood of receiving TAVR. In adjusted analyses, TAVR was associated with lower in-hospital mortality compared with SAVR (adjusted OR 0.33, 95% CI 0.29–0.37; p<0.001) and significantly shorter hospital length of stay (−73.4%, 95% CI −73.8% to −73.0%; p<0.001). In a propensity-adjusted cohort including 92,705 hospitalizations, TAVR remained associated with lower in-hospital mortality (adjusted OR 0.36, 95% CI 0.31–0.42; p<0.001).
Conclusions: From 2016 to 2022, TAVR use increased markedly while SAVR declined in U.S. hospitalizations with aortic stenosis. TAVR was associated with lower in-hospital mortality and shorter hospitalization, and these findings remained consistent after propensity adjustment.