Transcatheter Versus Surgical Aortic Valve Replacement in Solid Organ Transplant Recipients and Liver Cirrhosis: A Propensity Matched Analysis of National Readmission Data.

BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) continues to grow in the US. There is limited data on solid organ transplant (SOT) recipients and liver cirrhosis patients undergoing aortic valve replacement (AVR). Our study aims to evaluate outcomes in these populations.

METHODS: Using the national readmission database (2016-2020), We identified SOT recipients and liver cirrhosis patients without prior liver transplants admitted for severe aortic stenosis and underwent either TAVR or surgical aortic replacement (SAVR). We used multivariable regression for adjusted analysis and the Propensity Score Matching model, implementing complete Mahalanobis Distance Matching within the Propensity Score Caliper (0.2) to match TAVR and SAVR cohorts for outcomes.

RESULTS: Among 3,394 hospitalizations for (AVR) in SOT recipients, 2,181 underwent TAVR, and 1,213 underwent SAVR. On propensity-matched analysis, SAVR compared to TAVR was associated with higher adverse events, including in-hospital mortality (5.2% vs. 1.1%, adjusted odds ratio (aOR): 4.49, p < 0.001), acute kidney injury (AKI) (43.7% vs. 10.2%, p < 0.001), cardiogenic shock (9.0% vs. 1.6%, p < 0.001), sudden cardiac arrest (15.9 vs. 6.0%, p < 0.001), major adverse cardiac and cerebrovascular events (MACCE) (28% vs. 10.4%, p < 0.001) and net adverse events (72.8 vs. 37.6%, p < 0.001). A higher median length of stay (LOS) (10 vs. 2 days, p < 0.001) and adjusted cost ($80,842 vs $57,014, p < 0.001) were also observed. The readmission rates were the same for both cohorts after a six-month follow-up. Similarly, among 14,763 hospitalizations for AVR in liver cirrhosis, 7,109 underwent TAVR, and 7,654 underwent SAVR. In propensity-matched cohorts (N=2,341), SAVR was found to be associated with higher adverse events, including in-hospital mortality (19.8% vs. 10%, aOR: 5.52), stroke (6.7% vs. 2%), AKI (67.7% vs. 30.3%), cardiogenic shock (41.9% vs. 19.9%), sudden cardiac arrest (31.8% vs. 13.2%, aOR: 2.89), MACCE (66.2% vs. 35.7%) and net adverse events (86% vs. 59.5%) [p-value < 0.001]. A higher median LOS (16 vs. 3 days) and cost ($500,218 vs $263,383) were also observed [p-value < 0.001]. However, the rate of readmissions at 30-day (9% vs. 11.1%) and 180-day intervals (33.4% vs. 39.8%) were lower for the SAVR cohort [p-value<0.05].

CONCLUSION: In solid organ transplant recipients and liver cirrhosis patients, SAVR is associated with higher short-term mortality, adverse events, and healthcare burden as compared to TAVR. TAVR is a relatively safer alternative to SAVR in these patient populations, although further studies are warranted to compare the long-term outcomes.