Trends in Aortic Valve Replacement Procedures between 2016 and 2020 - Abstract
Background: Transcatheter aortic valve replacement (TAVR) has profoundly impacted the volume and outcomes of aortic valve interventions in the past decade.
Methods: This retrospective study used the annual Medicare Provider Analysis and Review file to identify all Medicare beneficiaries undergoing an isolated aortic valve procedure between 2016 and 2020. Outcome measures included in-hospital and short-term mortality rates and in-hospital adverse events.
Results: During the study period, the number of Medicare beneficiaries undergoing an isolated aortic valve procedure increased from 56,958/year to 79,972/year: a compounded annual growth rate of 8.5%. Transcatheter aortic valve replacement (TAVR) procedures per 100,000 Medicare beneficiaries grew from 58.9 in 2016 to 110.6 in 2020; while SAVR procedures per 100,000 Medicare beneficiaries decreased from 43.46 in 2016 to 19.19 in 2020. In-hospital, 30-day and 90-day post-discharge mortality rates declined annually for Medicare beneficiaries undergoing TAVR of procedures, while mortality rates for SAVR decrease until 2019, but increase in 2020. By 2020, <20% of Medicare beneficiaries undergoing TAVR had an adverse event during the index hospitalization. However, SAVR adverse events increased slightly from 45.2% in 2016 to 47.6% in 2020.
Conclusions: Between 2016 and 2020, the total number of Medicare beneficiaries undergoing isolated aortic valve procedures per year increased from 102.5 to 129.9 per 100,000 Medicare beneficiaries during the study period— reflecting substantial growth in TAVR with contraction of SAVR. During this time period, there was an overall improvement in survival rates and reduction in adverse outcomes.