Greater access to TAVR may be associated with improved outcomes in patients with severe aortic stenosis, data suggest.
In an observational, retrospective cohort study that included almost 22,000 patients who received TAVR, the 30-day mortality rate was 3.1% in Ontario, where access was lower, and 2.5% in New York State, where access was greater.
Access site, urgency status, and year of procedure were the most important influences on mortality. Patients who had transfemoral TAVR had a 58% lower mortality rate than did those who did not. Mortality risk was more than twice as high for patients who had urgent TAVR . Finally, mortality rates were higher in the early years of the study period.
The investigators noted that Ontario patients were likely sicker than were those in New York because the province had restricted TAVR access to inoperable and high-risk patients during the study period, whereas New York did not. The reduction of the gap in short-term outcomes between the two locations when urgent cases were excluded from the analysis suggests that New York has a lower bar for performing urgent procedures in wait-listed patients.
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