Evolution of Surgical Aortic Valve Replacement in the Era of Transcatheter Valve Technology

Mantha, Aditya; Juo, Yen-Yi; Morchi, Ravi; Ebrahimi, Ramin; Ziaeian, Boback; Shemin, Richard J.; Benharash, Peyman

doi:10.1001/jamasurg.2017.2344

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…[3] Although SAVR has great long-term postoperative improvement, the consequences associated with thoracotomy, cardiac arrest, cardiopulmonary bypass and other procedures preclude surgery for patients with underlying diseases or older age. [4,5] In addition, the nonphysiological hemodynamics caused by the geometry and rigid materials of the mechanical valve require patients to rely on long-term anticoagulant therapy. [6,7] In the early 2000s, the world's first human transcatheter aortic valve replacement (TAVR) was successfully completed by Alain Cribier, which pioneered the interventional treatment of valvular disease.…”

Section: Introductionmentioning

confidence: 99%

“…Traditional surgical aortic valve replacement (SAVR) which was firstly employed in clinical trail in the 1960s, is still the basic choice for the treatment [3] . Although SAVR has great long‐term postoperative improvement, the consequences associated with thoracotomy, cardiac arrest, cardiopulmonary bypass and other procedures preclude surgery for patients with underlying diseases or older age [4,5] . In addition, the non‐physiological hemodynamics caused by the geometry and rigid materials of the mechanical valve require patients to rely on long‐term anticoagulant therapy [6,7] .…”

Section: Introductionmentioning

confidence: 99%

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Prosthetic heart valves for transcatheter aortic valve replacement

Peng

et al. 2023

BMEMat

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Transcatheter aortic valve replacement (TAVR) has the advantages of less trauma and faster postoperative recovery, which has brought the possibility to the elderly patient with valvular heart disease and is gradually replacing surgical aortic valve replacement (SAVR). The interventional valve used in TAVR needs to be compressed and transported through the catheter to the lesion site, and can still recover its original shape, structure and performance. This process requires that the material should be flexible, and the rigid mechanical valves in SAVR are not suitable. Recently, decellularized biological valves have been widely used in clinical practice, but their poor durability causes a limitation for long-term implantation. Therefore, the anti-calcification modification of biological valves and the design of new polymeric valves with good biostability have gained considerable attention. This review summarizes the calcification mechanism of biological valves and the research progress in anti-calcification modification strategies. Besides, the development of new polymeric valves is included, withThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prosthetic heart valves for transcatheter aortic valve replacement

Peng

et al. 2023

BMEMat

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“…In light of improved outcomes and expanding applications for transcatheter aortic valve replacements (TAVR), it is important to understand whether there has been a concomitant increase in access to and utilization of this expensive procedure. 1,2 Maryland's healthcare payment structure allows for a case study of TAVR utilization in a policy-driven, cost-constrained system. In 2014, Maryland enacted a state-wide all-payer, globally budgeted system termed the All Payer Model.…”

Section: Introductionmentioning

confidence: 99%

The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions

Yesantharao

Etchill

Zhou

et al. 2023

Cathet Cardio Intervent

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Background Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost‐constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland's All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries. Methods This was a quasi‐experimental investigation of Maryland Medicare patients undergoing TAVR between 2012 and 2018. New Jersey data were used for comparison. Longitudinal interrupted time series analyses were used to study TAVR utilization and difference‐in‐differences analyses were used to investigate post‐TAVR readmissions. Results During the first year of payment reform (2014), TAVR utilization among Maryland Medicare beneficiaries dropped by 8% (95% confidence interval [CI]: −9.2% to −7.1%; p < 0.001), with no concomitant change in TAVR utilization in New Jersey (0.2%, 95% CI: 0%–1%, p = 0.09). Longitudinally, however, the All Payer Model did not impact TAVR utilization in Maryland compared to New Jersey. Difference‐in‐differences analyses demonstrated that implementation of the All Payer Model was not associated with significantly greater declines in 30‐day post‐TAVR readmissions in Maryland versus New Jersey (−2.1%; 95% CI: −5.2% to 0.9%; p =0.1). Conclusions Maryland's All Payer Model resulted in an immediate decline in TAVR utilization, likely a result of hospitals adjusting to global budgeting. However, beyond this transition period, this cost‐constrictive reform measure did not limit Maryland TAVR utilization. In addition, the All Payer Model did not reduce post‐TAVR 30‐day readmissions. These findings may help inform expansion of globally budgeted healthcare payment structures.

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