Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement for Aortic Stenosis (SAVR): A Cost-Comparison Study

Shah, Karan; Elder, D.; Nguyen, Michael; Turner, Lisa; Doyle, Mathew; Woldendorp, Kei; Seco, Michael; Law, C. K.; Wilson, Michael K.; Keech, Anthony; Ng, M.; Morton, Rachael L.

doi:10.1016/j.hlc.2021.05.088

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…The combination of the gamma distribution and log‐link was used to account for response variable skewness, and thus accurately model the distributions of PHLOS and cost (given the flexible shape of its probability distribution function, the gamma distribution is able to mimic the log‐normal distribution often assumed by continuous, non‐negative, right‐skewed data). 26 , 27 Time from discharge to late mortality or transplant was evaluated using the Kaplan–Meier method. The relationship between SES tertile and late mortality or transplant was assessed using the Cox proportional hazards model.…”

Section: Methodsmentioning

confidence: 99%

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Sengupta

Bucholz

Schroeder

et al. 2023

JAHA

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Background The impact of neighborhood socioeconomic status (SES) on outcomes following first‐stage palliation of single ventricle heart disease remains incompletely characterized. Methods and Results This was a single‐center, retrospective review of consecutive patients who underwent the Norwood procedure from January 1, 1997 to November 11, 2017. Outcomes of interest included in‐hospital (early) mortality or transplant, postoperative hospital length‐of‐stay, inpatient cost, and postdischarge (late) mortality or transplant. The primary exposure was neighborhood SES, assessed using a composite score derived from 6 US census‐block group measures related to wealth, income, education, and occupation. Associations between SES and outcomes were assessed using logistic regression, generalized linear, or Cox proportional hazards models, adjusting for baseline patient‐related risk factors. Of 478 patients, there were 62 (13.0%) early deaths or transplants. Among 416 transplant‐free survivors at hospital discharge, median postoperative hospital length‐of‐stay and cost were 24 (interquartile range, 15–43) days and $295 000 (interquartile range, $193 000–$563 000), respectively. There were 97 (23.3%) late deaths or transplants. On multivariable analysis, patients in the lowest SES tertile had greater risk of early mortality or transplant (odds ratio [OR], 4.3 [95% CI, 2.0–9.4; P <0.001]), had longer hospitalizations (coefficient 0.4 [95% CI, 0.2–0.5; P <0.001]), incurred higher costs (coefficient 0.5 [95% CI, 0.3–0.7; P <0.001]), and had greater risk of late mortality or transplant (hazard ratio, 2.2 [95% CI, 1.3–3.7; P =0.004]), compared with those in the highest tertile. The risk of late mortality was partially attenuated with successful completion of home monitoring programs. Conclusions Lower neighborhood SES is associated with worse transplant‐free survival following the Norwood operation. This risk persists throughout the first decade of life and may be mitigated with successful completion of interstage surveillance programs.

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Section: Methodsmentioning

confidence: 99%

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Sengupta

Bucholz

Schroeder

et al. 2023

JAHA

View full text Add to dashboard Cite

show abstract

“…The combination of the gamma distribution and log-link was used to account for response variable skewness, and therefore, accurately model the distributions of PHLOS and cost (given the flexible shape of its probability distribution function, the gamma distribution is able to mimic the log-normal distribution often assumed by continuous, nonnegative, right-skewed data). 26,27 The association between childhood opportunity level and late mortality or transplant was assessed using the Cox proportional hazards model. Finally, the Fine–Gray competing risk model was used to evaluate the relationship between childhood opportunity level and late reintervention, with postdischarge death or transplantation as the competing event.…”

Section: Methodsmentioning

confidence: 99%

Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery

et al. 2022

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Background: While singular measures of socioeconomic status have been associated with outcomes after surgery for congenital heart disease, the multifaceted pathways through which a child’s environment impacts similar outcomes remain incompletely characterized. We sought to evaluate the association between childhood opportunity level and adverse outcomes after congenital heart surgery. Methods: Data from patients undergoing congenital cardiac surgery from January 2011 to January 2020 at a quaternary referral center were retrospectively reviewed. Outcomes of interest included predischarge (early) mortality or transplant, postoperative hospital length-of-stay, inpatient cost of hospitalization, postdischarge (late) mortality or transplant, and late unplanned reintervention. The primary predictor was a US census tract–based, nationally-normed composite metric of contemporary child neighborhood opportunity comprising 29 indicators across 3 domains (education, health and environment, and socioeconomic), categorized as very low, low, moderate, high, and very high. Associations between childhood opportunity level and outcomes were evaluated using logistic regression (early mortality), generalized linear (length-of-stay and cost), Cox proportional hazards (late mortality), or competing risk (late reintervention) models, adjusting for baseline patient-related factors, case complexity, and residual lesion severity. Results: Of 6133 patients meeting entry criteria, the median age was 2.0 years (interquartile range, 3.6 months–8.3 years). There were 124 (2.0%) early deaths or transplants, the median postoperative length-of-stay was 7 days (interquartile range, 5–13 days), and the median inpatient cost was $76 000 (interquartile range, $50 000–130 000). No significant association between childhood opportunity level and early mortality or transplant was observed ( P =0.21). On multivariable analysis, children with very low and low opportunity had significantly longer length-of-stay and incurred higher costs compared with those with very high opportunity (all P <0.05). Of 6009 transplant-free survivors of hospital discharge, there were 175 (2.9%) late deaths or transplants, and 1008 (16.8%) reinterventions at up to 10.5 years of follow-up. Patients with very low opportunity had a significantly greater adjusted risk of late death or transplant (hazard ratio, 1.7 [95% CI, 1.1–2.6]; P =0.030) and reintervention (subdistribution hazard ratio, 1.9 [95% CI, 1.5–2.3]; P <0.001), versus those with very high opportunity. Conclusions: Childhood opportunity level is independently associated with adverse outcomes after congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.

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“…Since the first human transcatheter aortic valve implantation (TAVI) was performed in 2002, TAVI has been widely used in high-surgical risk elderly patients with severe aortic valve stenosis ( 1 ). Recently, indications for TAVI have expanded to include intermediate- and low-risk patients ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Vascular access site complications after transfemoral transcatheter aortic valve implantation: a comparison of open and percutaneous puncture approaches

Sumii,

Morisaki,

Okai

et al. 2023

J Thorac Dis

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Background In transfemoral transcatheter aortic valve implantation (TF-TAVI), which approach has lower vascular access site complications between the open puncture (OP) and percutaneous puncture (PP) approaches is still controversial. Moreover, few studies have analyzed risk factors for vascular access site complications in TF-TAVI. This study aimed to compare vascular access site complications between the OP and PP approaches in patients undergoing TF-TAVI and access risk factors for vascular access site complications. Methods Three hundred fifty-one patients who underwent TF-TAVI via the PP (n=251) and OP (n=100) were retrospectively examined. Results Incidence of vascular access site complications was 7.0% in the OP group and 8.4% in the PP group (P=0.828). Two deaths from vascular access site complications occurred in the PP group. After performing inverse probability weighting (IPW), regression analysis showed that PP was associated with a significantly higher odds of vascular access site complications [odds ratio =2.033; 95% confidence interval (CI): 1.397–2.958; P<0.001]. Common femoral artery (CFA) depth (hazard ratio =1.04; 95% CI: 1.000–1.070; P=0.045) and sheath/CFA diameter ratio (hazard ratio =971; 95% CI: 22.6–41,700; P<0.001) were independent complication risk factors. In patients with CFA depth ≥35 mm, the incidence of vascular access site complications was higher with PP than OP. Sheath/CFA diameter ratio ≥0.9 was associated with increased risk of vascular injury with both approaches. Conclusions The incidence of vascular access site complications in patients undergoing TF-TAVI was significantly lower with OP than PP after IPW. OP may be preferable when CFA depth is ≥35 mm. When the sheath/CFA diameter ratio is ≥0.9, approaches other than the TF approach should be considered.

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Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement for Aortic Stenosis (SAVR): A Cost-Comparison Study

Cited by 10 publications

References 18 publications

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery

Vascular access site complications after transfemoral transcatheter aortic valve implantation: a comparison of open and percutaneous puncture approaches

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