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Readmission Related Outcomes of Surgical versus Transcatheter Aortic Valve Replacement in Patients Aged 65 or Older with Bicuspid Aortic Valve
Takuya Ogami, Sarah Yousef, James A. Brown, Dustin E. Kliner, Catalin Toma, Derek Serna-Gallegos, Yisi Wang, Ibrahim Sultan.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Objective: There continues to be debate regarding the superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valves. We aimed to compare outcomes during readmissions in elderly patients with bicuspid aortic valve who underwent surgical aortic valve replacement (SAVR) or TAVR.
Methods: Patients 65 years or older who underwent SAVR or TAVR were identified using the National Readmission Database from 2012 through 2018. Patients who received mechanical aortic valves were excluded. We compared clinical outcomes during readmissions within 90 days after discharge from the index surgery. Propensity score matching was performed to adjust the baseline difference between the cohorts.
Results: During the study period, 7,527 and 600 elderly patients with bicuspid aortic valve underwent SAVR and TAVR, respectively. Propensity score matching yielded 582 patients in each group. A total of 124 (21.3%) in the SAVR group and 129 (22.2%) in the TAVR group were readmitted within 90 days after the index surgery (p=0.78). The mortality during the readmissions within 90 days was equivalent between two groups (4% in the SAVR group vs. 3.1% in the TAVR group, p=0.75). However, the median hospital cost was significantly higher in the TAVR group during the readmission (72,196 vs. 46,829 dollars in the SAVR group, p=0.04).
Conclusion: Readmission within 90 days was common in both groups. While the mortality during the readmissions after the surgery was equivalent between the two groups, hospital cost was significantly more expensive in the TAVR group.


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