Procedural Experience for Transcatheter Aortic Valve Replacement and Relation to Outcomes

Carroll, John D.; Vemulapalli, Sreekanth; Dai, Dadi; Matsouaka, Roland; Blackstone, Eugene H.; Edwards, Fred H.; Masoudi, Frederick A.; Mack, Michael J.; Peterson, Eric D.; Holmes, David R.; Rumsfeld, John S.; Tuzcu, E. Murat; Grover, Frederick L.

doi:10.1016/j.jacc.2017.04.056

Cited by 236 publications

(109 citation statements)

References 24 publications

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“…Carroll et al reported the learning curve associated with TAVR from the STS/ACC registry. According to the study, there was a linear association, meaning better outcomes with increased hospital volume for in‐hospital mortality, vascular complications, and bleeding events.…”

Section: Discussionmentioning

confidence: 99%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Ando

Adegbala

Villablanca

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in non‐teaching hospitals. Background TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non‐teaching hospitals are largely under explored. Methods We queried the Nationwide Inpatient Sample database from 2011 to September 2015 to identify those who were 50 years or above and underwent either trans‐arterial TAVR or SAVR at non‐teaching hospital. In‐hospital clinical outcomes were compared with odds ratio (OR) in propensity‐matched cohorts. Results We identified un‐weighted 957 and 7,465 SAVR admissions. In propensity‐matched model, 596 admissions in each arm were included for final analysis. In‐patient mortality (3.9 vs. 2.5%, OR 1.54, P = 0.34), acute kidney injury requiring dialysis (2.2 vs. 2.7%, OR 0.80, P = 0.57), stroke (2.0 vs. 3.2%, OR 0.61, P = 0.20), and pacemaker placement (8.9 vs. 6.4%, OR 1.47, P = 0.09) was similar between TAVR and SAVR. Sub‐group analysis showed that female and those with prior coronary artery bypass surgery had higher risk of in‐patient morality in TAVR admission. Cost was higher (59,103 vs. 53,411 dollars, P = 0.006) but length of stay was shorter in TAVR (6.9 vs. 10.2 days, P < 0.001). Conclusions TAVR conferred similar in‐hospital mortality and major peri‐procedural complications compared with SAVR in non‐teaching hospitals. For those with limited access to teaching hospitals, non‐teaching hospitals appear to be a reasonable option for candidates of aortic valve replacement for severe aortic stenosis.

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Section: Discussionmentioning

confidence: 99%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Ando

Adegbala

Villablanca

et al. 2018

Cathet Cardio Intervent

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“…One study compared procedure volume to adverse events. More volume was associated with less adverse outcomes including vascular complications and bleeding (22). This is an interesting look at prevention and argues for more specialized sites with high volume, allowing cardiologists to further perfect their techniques.…”

Section: Prevention Of Access Site Complicationsmentioning

confidence: 95%

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

et al. 2018

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Aortic stenosis (AS) is a common cause of valvular heart disease with heavy disease burden in elderly patients. It is present in almost 7% of patients older than 65. The mortality rate increases significantly once it becomes symptomatic with average life expectancy of around 1-year. Symptoms include angina, syncope, or heart failure. This requires either surgical or transcutaneous replacement. Transcutaneous aortic valve replacement (TAVR) use has increased in recent years from high risk patients to now even including intermediate risk patients. With the increased number of procedures performed, one of the consequences is access site complications. These complications can lead to increased hospitalization, cost, infections, and eventually worse outcomes. In this manuscript, we provide a comprehensive review discussing the consequences, outcomes, frequency, predictors and some possible solutions to these complications set forth in these studies.

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“…Lower in‐hospital risk‐adjusted outcomes such as mortality, bleeding, and vascular complications (but not stroke) were seen when site volume increased. In a volume‐outcome model, from the first case to 400th case, adjusted mortality (4–2%), bleeding (10–5%), vascular complications (6–4%), and stroke (2–1.6%) decreased significantly . “Public health discussions regarding hospital volumes required for starting or maintaining TAVR programs often stoke an impassioned debate: should we limit TAVR to high volume hospitals; or, should we allow TAVR at smaller hospitals to enhance patient access to a life‐saving treatment?”…”

Section: Risk Predictors and Specific Prognostic Markersmentioning

confidence: 99%

Transcatheter aortic valve replacement: The year in review 2017

Thakur

Nazif

Khalique

et al. 2018

J Interven Cardiology

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This article is a continuation of our previously published annual reviews of transcatheter aortic valve replacement (TAVR). In 2017, TAVR further established a foothold in the management of intermediate risk patients with the publication of SURTAVI trial. Randomized trials also addressed the use of cerebral protection during TAVR and single versus dual antiplatelet therapy after TAVR. Newer generation valve systems continued to be studied for their efficacy and safety. This paper summarizes the major studies published in 2017.

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Procedural Experience for Transcatheter Aortic Valve Replacement and Relation to Outcomes

Cited by 236 publications

References 24 publications

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

Transcatheter aortic valve replacement: The year in review 2017

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