• Talha Mubashir, Julius Balogh, Rabail Chaudhry, Cooper Quiroz, Biswajit Kar, Ismael A Salas De Armas, Yafen Liang, Travis Markham, Rishi Kumar, Warren Choi, Bindu Akkanti, Igor Gregoric, George Williams, and John Zaki.
• Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX.
• J. Cardiothorac. Vasc. Anesth. 2021 Mar 1; 35 (3): 888-895.

ObjectivesTo determine in-hospital outcomes and assess high-risk groups among chronic heart failure (CHF) patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).DesignA retrospective analysis of the Nationwide Inpatient Sample database from January 2012 to September 2015 was performed.SettingHospitals across the United States that offer TAVRs or SAVRs.ParticipantsAdults with a diagnosis of CHF and AS.InterventionsThe patients underwent either TAVR or SAVR.Measurements And Main ResultsTotals of 5,871 and 4,008 CHF patients underwent TAVR and SAVR, respectively. TAVR patients were significantly older, more were female, and had a higher comorbidity burden. No significant differences in in-hospital mortality were noted between TAVR and SAVR. However, mean length of stay was significantly longer by 3.5 days in the SAVR group, as was the mean total cost. With the exception of complete heart block, permanent pacemaker implantation, and vascular complications, the majority of postoperative events were higher among the SAVR group. Multivariate regression analysis identified postoperative cardiac, respiratory and renal complications as significant predictors of in-hospital mortality for both groups. Additionally, age ≥75 years and vascular complications were significant predictors of mortality for patients undergoing TAVR.ConclusionsAmong CHF patients with symptomatic AS, TAVR had similar in-hospital mortality rate compared with SAVR despite higher comorbidity burden. TAVR patients are at a lower risk of cardiovascular, respiratory, and renal complications and might lead to reduced length of hospital stay and cost. Hence, TAVR may be a safer option in this population.Copyright © 2020 Elsevier Inc. All rights reserved.

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