Background:Transcatheter aortic valve replacement (TAVR) has been performed more and more frequently in elderly patients with aortic stenosis. We investigated the association of in-hospital availability of TAVR on outcomes of surgical aortic valve replacement (SAVR) in the era of TAVR.

Methods and Results:We utilized data from the Japan Adult Cardiovascular Surgery Database. Between October 2013 and December 2016, 9,330 patients aged ≥80 years underwent isolated SAVR or SAVR with coronary artery bypass grafting in 557 centers in Japan. We assessed the associations of in-hospital TAVR availability with operative mortality and composite complications adjusting for each patient’s characteristics, JapanSCORE predicted the risk scores, and hospital volumes of SAVR using generalized estimation equation methods. Observed operative mortality rates were 3.4% in all centers, 2.0% in TAVR centers and 4.0% in non-TAVR centers. The multivariable analyses showed that TAVR centers had statistically significantly lower operative mortality compared with non-TAVR centers among all patients (odds ratio 0.60, 95% confidence interval 0.41–0.89, P=0.01) and among intermediate/high-risk patients (odds ratio 0.52, 95% confidence interval 0.32–0.85, P<0.01) but not among low-risk patients (odds ratio 0.82, 95% confidence interval 0.44–1.51, P=0.52).

Conclusions:In-hospital TAVR availability was associated with better outcomes of SAVR among elderly patients. This association was statistically significant among intermediate/high-risk patients but not significant among low-risk patients.

背景：经导管主动脉瓣置换术 (TAVR) 在老年主动脉瓣狭窄患者中越来越频繁地进行。我们调查了 TAVR 时代 TAVR 的院内可用性与外科主动脉瓣置换术 (SAVR) 结果之间的关联。

方法和结果：我们利用了日本成人心血管外科数据库中的数据。2013 年 10 月至 2016 年 12 月期间，9,330 名≥80 岁的患者在日本 557 个中心接受了单独的 SAVR 或冠状动脉旁路移植术的 SAVR。我们评估了住院 TAVR 可用性与手术死亡率和复合并发症的关联，并根据每个患者的特征进行调整，JapanSCORE 使用广义估计方程方法预测风险评分和 SAVR 的医院容量。观察到的手术死亡率在所有中心为 3.4%，在 TAVR 中心为 2.0%，在非 TAVR 中心为 4.0%。多变量分析显示，在所有患者中，TAVR 中心的手术死亡率显着低于非 TAVR 中心（优势比 0.60，95% 置信区间 0.41-0.89，P=0.

结论：院内 TAVR 可用性与老年患者更好的 SAVR 结局相关。这种关联在中/高风险患者中具有统计学意义，但在低风险患者中不显着。