Abstract 4366505: Transcatheter Aortic Valve Replacement Adoption Reduces Surgical Aortic Valve Replacement Utilization and Expands Access to Aortic Valve Replacement in Hawaii from 2012–2023

Abstract

Introduction: Transcatheter percutaneous aortic valve replacement (TAVR) was FDA-approved as an alternative to surgical aortic valve replacement (SAVR) in high (2012), intermediate (2016) and low-risk (2019) pts with aortic stenosis (AS). We assessed the impact of TAVR on SAVR in a marjority-minority population in Hawaii. Methods: We used data from The Queen’s Medical Center STS/ACC TVT and STS Adult Cardiac Surgery registries to identify all pts who underwent TAVR or isolated SAVR from 2012-23. We compared demographics, comorbidities, pre-op risk of mortality (ROM) score, procedural data and in-hospital outcomes. We used SPSS for descriptive analyses and parametric and non-parametric tests as appropriate. Results: From 2012-23, 1,732 pts had aortic valve replacement (AVR): 489 (28.2%) isolated SAVR and 1,243 (71.8%) TAVR. Whites, Asians, and Native Hawaiians underwent 38.1%, 47.6%, and 11.3% of procedures respectively. Total volume decreased during COVID-19 pandemic (2020-2023), with TAVR also negatively impacted in 2018-19 by changes in staffing. From 2012-23, each additional year was associated with a 21.0% increase in the odds of receiving TAVR vs. SAVR (OR 1.2, p < 0.001) - a corresponding 17.4% annual decrease in the odds of undergoing SAVR. The odds of receiving TAVR were 2.3 times higher during 2020-23 than before (p < 0.001). SAVR ROM significantly decreased with time (r = -0.170, p< 0.001). SAVR pts were younger (64.3 ± 12.5 vs. 79.1 ± 9.8 yrs, p < .001) with lower ROM (2.2 ± 3.2 vs 5.4 ± 4.2, p < .001) and more urgent procedures (14.7% vs 3.6%, p < 0.001). Conversely, TAVR pts were more often women (39.3% vs 28.8%, p < .001), with more diabetes (40.4% vs 31.3%, p < 0.001), prior MI (19.2% vs 9.4%, p < 0.001), and Medicaid/Medicare (84.8% vs 57.3%, p < 0.001). In-hospital mortality was significantly lower in TAVR vs SAVR (1.6% vs 3.3%, p = 0.02). Overall, the total number of AVRs increased 30.9% between 2013-14 (116.5 procedures/yr) and 2022-23 (152.5 procedures/yr). Among pts <65y, TAVR increased from 2013-14 to 2022-23 (9.1% vs. 42.6%) and SAVR decreased (90.9% vs.57.4%). Conclusion: With expanding indications for TAVR to include low-risk pts, annual TAVR volume has started to rebound following the COVID-19 pandemic. Despite fewer SAVRs, the annual number of all AVRs has substantially increased over the past decade, suggesting that TAVR has expanded access to AVRs to a broader range of pts.