Outcomes and Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with and Without Coronary Artery Disease

Abstract

Background: The aim of this study was to compare costs and clinical outcomes associated with transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). A secondary analysis was performed in patients with coronary artery disease, and patients with TAVI and percutaneous coronary intervention (PCI) were compared with SAVR and coronary artery bypass grafting (CABG). Methods: All patients who underwent the TAVI or SAVR procedure for severe degenerative aortic stenosis between August 2013 and February 2025 at a tertiary cardiovascular center were selected for inclusion in the present study. Patients were excluded if there was no available follow-up or if there was a crossover between treatments (especially CABG undergoing TAVI or SAVR undergoing PCI within a 6-month timeframe). Results: A total of 2452 patients (1925 undergoing SAVR and 527 undergoing TAVI) were included. Of those, 400 underwent SAVR + CABG and 75 underwent TAVI + PCI. During a median follow-up of 2.88 (1.12–6.43) years, a total of 404 all-cause events occurred, corresponding to 4.18 deaths per 100 patient-years. TAVI was associated with higher hospitalization costs and fewer in-hospital deaths than SAVR. However, long-term survival was similar between TAVI and SAVR and between TAVI + PCI and SAVR + CABG. Interventional treatment was more cost-effective in patients with EuroSCORE > 10%, while surgical treatment was more cost-effective in patients with EuroSCORE < 10%. Conclusions: In patients who are at high surgical risk, TAVI is more cost-effective than SAVR, and TAVI + PCI is more cost-effective than SAVR + CABG. In patients who are not at high surgical risk, SAVR is more cost-effective than TAVI, and SAVR + CABG is more cost-effective than TAVI + PCI.