Contrasting impacts of social deprivation and ethnicity on transcatheter aortic valve replacement vs surgical aortic valve replacement

Background — The association between social deprivation and cardiac valvular procedural outcomes is not well established. We sought to distinguish the relationship between social deprivation and outcomes after transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR).

Methods — Demographics, patient comorbidities, procedural details, and outcomes for adults undergoing TAVR and SAVR between April 2017 and March 2022 were obtained from clinical and administrative databases and linked to neighbourhood-level measures of social deprivation using the Ontario Marginalization Index in Ontario, Canada. Our outcomes were 30-day mortality, 30-day readmission, 1-year mortality, and 1-year readmission. Separate Cox proportional hazard models for postprocedural mortality and cause-specific hazard models for postprocedural readmission were used to determine the association between social deprivation and postprocedural outcomes after TAVR vs SAVR.

Results — We identified 6218 TAVR procedures and 3342 isolated SAVR procedures within our study period. After multivariable adjustment, TAVR was associated with lower 30-day mortality (hazard ratio [HR] 0.58; 95% confidence interval [CI] [0.37, 0.92]; P = 0.02), lower 30-day readmission rates (HR 0.75; 95% CI [0.63, 0.89]; P = 0.001), and a higher 1-year readmission rate (HR 1.14; 95% CI [1.02, 1.27]; P = 0.01), compared to SAVR. When the 3 index domains by treatment interactions were included in the analysis, the associations between TAVR and SAVR and these outcomes were not modified by the degree of neighbourhood social deprivation.

Conclusions — TAVR is associated with lower 30-day mortality and 30-day readmission rates and higher 1-year readmission compared to SAVR. These associations were not modified by markers of social deprivation.