In-Hospital Outcomes of Simultaneous and Staged Transcatheter Aortic Valve Replacement and Endovascular Aneurysm Repair.

Introduction: Patients with aortic aneurysms are at elevated risk of rupture, dissection and death during and after transcatheter aortic valve repair (TAVR), often requiring consideration for endovascular aneurysm repair (EVAR) at the time of TAVR. However, data comparing outcomes of simultaneous versus staged TAVR-EVAR are limited.

Methods: Using the National Inpatient Sample between the years 2018 and 2021, we compared in-hospital outcomes of simultaneous and staged TAVR-EVAR. Patients who underwent both TAVR and EVAR during hospital admission were identified with International Classification of Diseases 10th Revision procedure codes. Patients were stratified by simultaneous (defined as same day) versus staged (defined as different day) procedures. Propensity score matching was done in a 2:1 fashion to account for differences in baseline characteristics, and mixed effects multivariate regression models were used to assess differences in in-hospital mortality, cost of hospitalization, length of stay, and other procedural complications.

Results: A total of 270 patients underwent simultaneous TAVR-EVAR, while a total of 70 underwent staged TAVR-EVAR. After propensity score matching, 98 patients undergoing simultaneous TAVR-EVAR were matched to 49 patients undergoing staged TAVR-EVAR. No significant differences in baseline characteristics were observed after matching. In-hospital mortality between the matched groups was not significantly different (OR 0.67, p = 0.409), however the simultaneous group was associated with shorter length of stay (3 [2.0-11.75] days vs. 14 [13.0-17.0] days, p < 0.001) and less total hospital costs ($77,691 [$65,153-$103,854] vs. $148,617 [$128,339-$217,988]; p < 0.001). The matched simultaneous group was also associated with lower incidence of acute kidney injury (25.5% vs. 65.3%; OR 0.11, p < 0.001), blood transfusions (20.4% vs. 40.8%; OR 0.37, p = 0.01), and access site complications (< 10.2% vs. 49.0%; OR 0.00, p < 0.001).

Conclusion: Simultaneous TAVR-EVAR is associated with fewer adverse complications and lower cost of hospitalization without increased in-hospital mortality, suggesting it is more cost effective than staged TAVR-EVAR during the same hospital admission.