Development and In-Hospital Mortality of Transcatheter and Surgical Aortic Valve Replacement in 2015 in Germany

Objectives: The aim of this study was to evaluate the temporal trends of transcatheter aortic valve replacement (TAVR) in severe aortic stenosis (AS) patients with atrial fibrillation (AF) and to compare the in-hospital outcomes between TAVR and surgical aortic valve replacement (SAVR) in patients with AF.Background: Data comparing TAVR to SAVR in severe AS patients with AF are lacking.Methods: National inpatient sample database in the United States from 2012 to 2016 were queried to identify hospitalizations for severe aortic stenosis patients with AF who underwent isolated aortic valve replacement. A propensity score-matched analysis was used to compare in-hospital outcomes for TAVR vs. SAVR for AS patients with AF.Results: The analysis included 278,455 hospitalizations, of which 124,910 (44.9%) were comorbid with AF. Before matching, TAVR had higher in-hospital mortality than SAVR (3.1 vs. 2.2%, p < 0.001); however, there was a declining trend during the study period (Ptrend < 0.001). After matching, TAVR and SAVR had similar in-hospital mortality (2.9 vs. 2.9%, p < 0.001) and stroke. TAVR was associated with lower rates of acute kidney injury, new dialysis, cardiac complications, acquired pneumonia, sepsis, mechanical ventilation, tracheostomy, non-routine discharge, and shorter length of stay; however, TAVR was associated with more pacemaker implantation and higher cost. Of the patients receiving TAVR, the presence of AF was associated with an increased rate of complications and increased medical resource usage compared to those without AF.Conclusions: In-hospital mortality and stroke for TAVR and SAVR in AF, AS are similar; however, the in-hospital mortality in TAVR AF is declining and associated with more favorable in-hospital outcomes.

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Trend in morbidity and mortality in surgical aortic valve replacement: a retrospective, observational, single-centre study

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa189 ◽

2020 ◽

Vol 31 (6) ◽

pp. 796-802

Author(s):

Arnaldo Dimagli ◽

Shubhra Sinha ◽

Massimo Caputo ◽

Gianni D Angelini ◽

Umberto Benedetto

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Time Trend ◽

Perioperative Complications ◽

Single Centre ◽

Surgical Aortic Valve Replacement ◽

Mortality And Morbidity ◽

Baseline Characteristics

Abstract OBJECTIVES Continuous improvement in the management of patients undergoing surgical aortic valve replacement (SAVR) may have considerably enhanced surgical outcomes including in-hospital mortality and perioperative complications. We aimed to analyse in-hospital mortality and morbidity trends in patients undergoing SAVR in a single centre to provide insights for future benchmarking for transcatheter aortic valve implantation indications. METHODS This was a retrospective study of prospectively collected data from patients undergoing either isolated SAVR or combined with coronary artery bypass grafting (CABG) at the Bristol Heart Institute, UK, from January 2000 to December 2017. Baseline characteristics were extracted and analysed across 3 different eras (2000–2005, 2006–2011 and 2012–2017). Risk-adjusted time trend was obtained from univariate and multivariate logistic regression including all baseline characteristics. RESULTS A total of 2719 patients (63.2%) underwent isolated SAVR, and 1581 (36.8%) underwent combined CABG and SAVR during the study period. For patients undergoing SAVR, in-hospital mortality decreased from 2.9% in 2000–2005 to 0.7% in 2012–2017 (risk-adjusted time trend 0.0001). Hospital mortality in patients aged 75–79 and ≥80 years decreased from 5.6% and 5.3% to 0.4% and 2.2%, respectively. Mortality after combined SAVR and CABG did not significantly decrease (from 3.9% in 2000–2005 to 3.5% in 2012–2017; risk-adjusted time trend = 0.62). However, in patients aged ≥80 years, index hospitalization mortality showed a decreasing non-significant trend from 9.8% to 4.8%. CONCLUSIONS Our findings support the hypothesis that mortality and morbidity rates following SAVR have significantly improved over the years, including for patients at high risk.

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P925Risk adjusted comparison of in-hospital outcomes of transapical transcatheter and surgical aortic valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehz747.0520 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Stachon ◽

K K Kaier ◽

T H Heidt ◽

M Z Zehender ◽

C B Bode ◽

...

Keyword(s):

Mechanical Ventilation ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Prolonged Mechanical Ventilation ◽

Treatment Strategies ◽

Surgical Aortic Valve Replacement ◽

Data Set ◽

Hospital Outcomes

Abstract Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) is the standard therapy for patients with severe aortic valve stenosis at high operative risk. If the transfemoral access is not possible, a transapical access is an alternative. However, it is known from randomized trials and large registries that outcomes after transapical TAVR (TA-TAVR) are inferior to TF-TAVR. Purpose We compared in-hospital outcomes of patients undergoing TA-TAVR or SAVR in a nationwide data-set, in order to identify patients' groups, who benefit from SAVR or TA-TAVR. Methods We identified all 13,151 isolated SAVR and 4,625 TA-TAVR performed in Germany 2014 and 2015 on the basis of ICD- and OPS codes. In order to compare outcomes, we adjusted for risk factors using a covariate adjusted analysis. Results Patients undergoing TA-TAVR were older (68 vs. 80 years), had more co-morbidities, and accordingly an increased logistic EuroSCORE (LogES 5.3 vs 16.7%). However, stroke, acute kidney injuries, relevant bleedings, and prolonged mechanical ventilation occurred less frequently in patients undergoing TA-TAVR (OR TA-TAVR vs SAVR: stroke 0.66, p=0.017; acute kidney injury 0.72, p=0.002; relevant bleeding: 0.38, p<0.001; prolonged mechanical ventilation >48h: 0.5, p≤0.001). The risk for a new permanent pacemaker was higher after TA-TAVR (OR 2.44, p≤0.001). Without adjustment in-hospital mortality was higher after TA-TAVR (2.0% vs. 5.9%). After covariate adjustment, the difference disappeared (OR TA-TAVR vs. SAVR 1.2, p=0.136). In order to identify subgroups, which may benefit from TA-TAVR or SAVR, we compared mortality in different subgroups after risk adjustment. Patients under 75 years (OR TA-TAVR vs. SAVR: 1.86, p=0.01) and female (OR 1.48, p=0.043) patients had a lower risk for in-hospital mortality after SAVR. In all other groups (age 75–79, 80–84, >85, log. EuroScore <4, 4–9,>9, NYHA III/IV, previous CABG, COPD, pulmonary hypertension, chronic renal failure, Diabetes) none of both treatment strategies was superior. Conclusion TA-TAVR is with regard to in-hospital mortality not superior to SAVR in clinical practice. Younger patients under 75 years and female patients benefit from SAVR. However, complications such as bleeding, stroke, or prolonged ventilation were less frequently in patients undergoing TA-TAVR.

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In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2015.05.068 ◽

2015 ◽

Vol 150 (3) ◽

pp. 571-578.e8 ◽

Cited By ~ 18

Author(s):

Shikhar Agarwal ◽

Aatish Garg ◽

Akhil Parashar ◽

Lars G. Svensson ◽

E. Murat Tuzcu ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement

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Comparing Trajectory of Surgical Aortic Valve Replacement in the Early vs. Late Transcatheter Aortic Valve Replacement Era

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.680123 ◽

2021 ◽

Vol 8 ◽

Author(s):

Gabby Elbaz-Greener ◽

Guy Rozen ◽

Fabio Kusniec ◽

Ibrahim Marai ◽

Shemy Carasso ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Downward Trend ◽

Upward Trend ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve

Background: Traditionally, the only effective treatment for aortic stenosis was surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011 and provided a critical alternative therapy. Our aims were to investigate the trends in the utilization of SAVR in the early vs. late TAVR era and to assess SAVR and TAVR outcomes.Methods: Using the 2011–2017 National Inpatient Sample database, we identified hospitalizations for patients with a most responsible diagnosis of aortic stenosis during which an aortic valve replacement (AVR) was performed, either SAVR or TAVR. Patients' sociodemographic and clinical characteristics, procedure complications, length of stay, and mortality were analyzed. Multivariable analyses were performed to identify predictors of in-hospital mortality. Piecewise regression analyses were performed to assess temporal trends in SAVR and TAVR utilization.Results: A total of 542,734 AVR procedures were analyzed. The utilization of SAVR was steady until 2014 with a significant downward trend in the following years 2015–2017 (P = 0.026). In contrast, a steady upward trend was observed in the TAVR procedure with a significant increase during the years 2015–2017 (P = 0.006). Higher in-hospital mortality was observed in SAVR patients. The mortality rate declined from 2011 to 2017 in a significantly higher proportion in the TAVR compared with the SAVR group.Conclusion: Utilization of SAVR showed a downward trend during the late TAVR era (2015–2017), and TAVR utilization demonstrated a steady upward trend during the years 2011–2017. Higher in-hospital mortality was recorded in patients who underwent SAVR.

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Trends of Uptake and In-Hospital Mortality for Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Nonagenarians

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.12.002 ◽

2019 ◽

Vol 123 (4) ◽

pp. 703-705 ◽

Cited By ~ 4

Author(s):

Islam Y. Elgendy ◽

Ahmed N. Mahmoud ◽

Ayman Elbadawi ◽

Akram Y. Elgendy ◽

Dhruv Mahtta ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement: A Meta-Analysis

Angiology ◽

10.1177/0003319720941761 ◽

2020 ◽

Vol 71 (10) ◽

pp. 955-965

Author(s):

Jiayang Wang ◽

Xinxin Wang ◽

Fangjie Hou ◽

Wen Yuan ◽

Ran Dong ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve

We determined the incidence, clinical characteristics, and risk factors of post-transcatheter aortic valve replacement (TAVR)–associated infective endocarditis (IE). We compared the incidence of IE after TAVR versus after surgical aortic valve replacement (SAVR). The incidence rate of IE 1-year post-TAVR was 0.9% (95% confidence interval [CI]: 0.8-1.0). Transcatheter aortic valve replacement was associated with significantly reduced IE incidence (incidence rate ratio: 0.69, 95% CI: 0.52-0.92, P = .011) compared with SAVR. In patients with TAVR IE, the pooled in-hospital mortality was 37.8% (95% CI: 32.4-43.3, I 2 = 54.9%). Pooled adjusted hazard ratio (HR) revealed that peri-procedural peripheral artery disease (HR: 4.02, 95% CI: 2.28-7.10, P < .0001), moderate or severe residual aortic regurgitation (HR: 2.34, 95% CI: 1.53-3.59, P < .0001), orotracheal intubation (HR: 2.13, 95% CI: 1.19-3.82, P = .011), and male gender (HR: 1.70, 95% CI: 1.47-1.97, P < .0001) were risk factors for post-TAVR IE. Post-TAVR IE is a life-threatening complication often resulting in in-hospital mortality. The current evidence-based meta-analysis to identify risk factors may lead to the development of effective preventive and therapeutic strategies for post-TAVR IE to ultimately improve patient outcomes.

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