E-22 | Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Aortic Stenosis and Cardiogenic Shock

Patients with aortic stenosis (AS) and cardiogenic shock (CS) are an extremely high-risk population. How transcatheter aortic valve replacement (TAVR) outcomes compare to surgical AVR (SAVR) outcomes in patients with AS-CS remains unknown. We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for AS-CS from 2016-2020 who underwent isolated TAVR or SAVR. In-hospital outcomes of TAVR vs. SAVR were compared using multivariable regression analysis. Of 13,215 patients hospitalized for AS-CS, 5,095 (38.6%) underwent isolated TAVR, and 8,120 (61.4%) underwent isolated SAVR. From 2016 through 2020, the use of TAVR increased, while the use of SAVR decreased in AS-CS (both ptrend<0.01). Factors independently associated with TAVR selection in AS-CS included age ≥65 years, female sex, renal failure, chronic pulmonary disease, prior coronary artery bypass grafting, and impella support. Factors independently associated with SAVR selection included Black race, Hispanic ethnicity, and peripheral vascular disease. Compared with SAVR, TAVR was associated with lower odds of stroke (adjusted odds ratio [aOR] 0.48, 95% confidence interval [CI] 0.27-0.85), acute kidney injury, and major bleeding. In-hospital mortality, pacemaker placement, and vascular complications were similar. Length of stay was shorter and total costs were lower with TAVR (both p<0.01). This nationwide observational analysis showed that TAVR is a feasible treatment option for patients with AS-CS with lower in-hospital complications and resource utilization compared with SAVR.