Outcomes, Readmissions and Costs in Transfemoral and Alterative Access Transcatheter Aortic Valve Replacement in the U.S. Medicare Population

Abstract Objective Utilization, outcomes and, particularly, cost between transfemoral (TF), transapical (TA) and transaortic (TAO) transcatheter aortic valve replacement (TAVR) patients have yet to be comprehensively evaluated. Methods All Medicare fee-for-service patients undergoing TF (n=4065), TA (n=691), or TAO (n=274) TAVR between January 1, 2011 and November 30, 2012 were identified using Health Care Procedure Classification Codes present on Medicare claims. Hospital charges from Medicare claims were converted to costs using hospital-specific Medicare cost-to-charge ratios. Results TA and TAO patients were similar in age, race, and common comorbidities. Compared to TF patients, TA and TAO patients were more likely to be female and to have peripheral vascular disease, chronic lung disease, and renal failure. Thirty-day mortality rates were higher among TA and TAO patients than among TF patients (TA=9.6%, TAO=8.0%, TF=5.0%, p