Abstract
Introduction
Prosthesis choice during aortic valve replacement (AVR) weighs lifelong anticoagulation
with mechanical valves (M-AVR) against structural valve degeneration in bioprosthetic
valves (B-AVR).
Methods
The Nationwide Readmissions Database was queried to identify patients who underwent
isolated surgical AVR between January 1, 2016 and December 31, 2018, stratifying by
prothesis type. Propensity score matching was used to compare risk-adjusted outcomes.
Readmission at 1 y was estimated with Kaplan–Meier (KM) analysis.
Results
Patients (n = 109,744) who underwent AVR (90,574 B-AVR and 19,170 M-AVR) were included. B-AVR
patients were older (median 68 versus 57 y; P < 0.001) and had more comorbidities (mean Elixhauser score: 11.8 versus 10.7; P < 0.001) compared to M-AVR patients. After matching (n = 36,951), there was no difference in age (58 versus 57 y; P = 0.6) and Elixhauser score (11.0 versus 10.8; P = 0.3). B-AVR patients had similar in-hospital mortality (2.3% versus 2.3%; P = 0.9) and cost (mean: $50,958 versus $51,200; P = 0.4) compared with M-AVR patients. However, B-AVR patients had shorter length of
stay (8.3 versus 8.7 d; P < 0.001) and fewer readmissions at 30 d (10.3% versus 12.6%; P < 0.001) and 90 d (14.8% versus 17.8%; P < 0.001), and 1 y (P < 0.001, KM analysis). Patients undergoing B-AVR were less likely to be readmitted
for bleeding or coagulopathy (5.7% versus 9.9%; P < 0.001) and effusions (9.1% versus 11.9%; P < 0.001).
Conclusions
B-AVR patients had similar early outcomes compared to M-AVR patients, but lower rates
of readmission. Bleeding, coagulopathy, and effusions are drivers of excess readmissions
in M-AVR patients. Readmission reduction strategies targeting bleeding and improved
anticoagulation management are warranted in the first year following AVR.
Keywords
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Article info
Publication history
Published online: March 16, 2023
Accepted:
January 27,
2023
Received in revised form:
December 12,
2022
Received:
February 28,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
