Journal article
Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database)
The American journal of cardiology, Vol.116(8), pp.1229-1236
10/15/2015
DOI: 10.1016/j.amjcard.2015.07.039
PMID: 26297512
Abstract
We hypothesized that the availability of a transcatheter aortic valve implantation (TAVI) program in hospitals impacts the overall management of patients with aortic valve disease and hence may also improve postprocedural outcomes of conventional surgical aortic valve replacement (SAVR). The aim of the present study was to compare the inhospital outcomes of SAVR in centers with versus without availability of a TAVI program in an unrestricted large nationwide patient population >50 years of age. SAVRs performed on patients aged >50 years were identified from the Nationwide Inpatient Sample (NIS) for the years 2011 and 2012 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. SAVR cases were divided into 2 categories: those performed at hospitals with a TAVI program (SAVR-TAVI) and those without (SAVR-non-TAVI). A total of 9,674 SAVR procedures were identified: 4,526 (46.79%) in the SAVR-TAVI group and 5,148 (53.21%) in SAVR-non-TAVI group. The mean age of the study population was 70.2 ± 0.1 years with majority (53%) of the patients aged >70 years. The mean Charlson's co-morbidity score for patients in SAVR-TAVI group was greater (greater percentage of patients were aged >80 years, had hypertension, congestive heart failure, renal failure, and peripheral arterial disease) than that of patients in SAVR-non-TAVI group (1.6 vs 1.4, p <0.001). The propensity score matching analysis showed a statistically significant lower inhospital mortality (1.25% vs 1.72%, p = 0.001) and complications rate (35.6% vs 37.3%, p = 0.004) in SAVR-TAVI group compared to SAVR-non-TAVI group. The mean length of hospital stay was similar in the 2 groups the cost of hospitalization was higher in the SAVR-TAVI group ($43,894 ± 483 vs $41,032 ± 473, p <0.0001). Having a TAVI program was a significant predictor of reduced mortality and complications rate after SAVR in multivariate analysis. In conclusion, this largest direct comparative analysis demonstrates that SAVRs performed in centers with a TAVI program are associated with significantly lower mortality and complications rates compared to those performed in centers without a TAVI program.
Details
- Title: Subtitle
- Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database)
- Creators
- Vikas Singh - Cardiology Department, University of Miami Miller School of Medicine, Miami, FloridaApurva O Badheka - Interventional Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.comSamir V Patel - Internal Medicine Department, Western Reserve Health System, Youngstown, OhioNileshkumar J Patel - Cardiology Department, University of Miami Miller School of Medicine, Miami, FloridaBadal Thakkar - Epidemiology Department, Tulane School of Public Health and Tropical Medicine, New Orleans, LouisianaNilay Patel - Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New JerseyShilpkumar Arora - Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New YorkNish Patel - Cardiology Department, University of Miami Miller School of Medicine, Miami, FloridaAchint Patel - Public Health Department, Icahn School of Medicine at Mount Sinai, New York, New YorkChirag Savani - Epidemiology Department, New York Medical College, Valhalla, New YorkAbhijit Ghatak - Cardiology Department, University of Miami Miller School of Medicine, Miami, FloridaSidakpal S Panaich - Cardiology Department, Detroit Medical Center, Detroit, MichiganSunny Jhamnani - Interventional Cardiology Department, The Everett Clinic, Everett, WashingtonAbhishek Deshmukh - Cardiology Department, Mayo Clinic, Rochester, MinnesotaAnkit Chothani - Internal Medicine Department, MedStar Washington Hospital Center, Washington, DCRajesh Sonani - Internal Medicine Department, Emory University School of Medicine, Atlanta, GeorgiaAashay Patel - Internal Medicine Department, Lankenau Institute for Medical Research, Wynnewood, PennsylvaniaParth Bhatt - Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New JerseyAbhishek Dave - Public Health Department, Texas A&M Medical Centre, College Station, TexasRonak Bhimani - Internal Medicine Department, St. Vincent Charity Medical Centre, Cleveland, OhioTamam Mohamad - Cardiology Department, Detroit Medical Center, Detroit, MichiganCindy Grines - Cardiology Department, Detroit Medical Center, Detroit, MichiganMichael Cleman - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutJohn K Forrest - Cardiology Department, Yale School of Medicine, New Haven, ConnecticutAbeel Mangi - Cardiology Department, Yale School of Medicine, New Haven, Connecticut
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.116(8), pp.1229-1236
- DOI
- 10.1016/j.amjcard.2015.07.039
- PMID
- 26297512
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Language
- English
- Date published
- 10/15/2015
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094359302771
Metrics
20 Record Views