TCT-746 Differences in Transcatheter Aortic Valve Replacement (TAVR) Outcomes by Gender and Race Over Time

Objective Transcatheter aortic valve replacement is now commercially available for intermediate-risk, high-risk, or inoperable patients with severe aortic stenosis. In this study, we investigated change in the safety and efficiency of the transcatheter aortic valve replacement procedure at our institution and patient outcomes comparing our first 100, second 100, and last 100 patients. Methods From March 2012 to June 2016, 544 patients underwent transcatheter aortic valve replacement at our center. Three hundred patients were selected for this study and were categorized in the following three groups: group A, first to 100th patient; group B, 101st to 200th patient; and group C, 444th to 544th patient. Preoperative, intraoperative, and postoperative data were collected. Results Three hundred patients, 162 male (54%) male and 138 female (46%) with a mean ± SD age of 79.10 ± 8.93 years and mean ± SD society of thoracic surgeons’ risk score of 7.47 ± 0.76 were included. Fluoroscopy time, operation time, and incision time significantly decreased form group A to group C (all P < 0.05). Mean of contrast volume was also the highest in group A and the lowest in group C ( P < 0.001). Acute kidney injury rate was 26% (n = 26) in group A versus 23% (n = 23) in group B ( P = 0.743), and only one patient in group C (group C vs. group B, P < 0.001). Strokes declined over time: five (5%) stroke in group A; two (2%) stroke in group B, and no patient in group C (group C vs. group B, P = 0.1, and group C vs. group A, P = 0.059). In-hospital mortality was 5% (n = 5) in group A, 4% (n = 4) in group B, and 1% in group C ( P = 0.21). Conclusions Progressive experience and technology advances with transcatheter aortic valve replacement procedures improved operators’ expertise, making the transcatheter aortic valve replacement more efficient and safer over time.

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REDUCTION IN RADIATION AND CONTRAST DOSE IN TRANSCATHETER AORTIC VALVE REPLACEMENT OVER TIME: A SINGLE-CENTER EXPERIENCE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31690-5 ◽

2018 ◽

Vol 71 (11) ◽

pp. A1149

Author(s):

Edwin Grajeda ◽

Abdulah Alrifai ◽

Mohamad Kabach ◽

Jesus Pino ◽

Fergie Ramos Tuarez ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Single Center ◽

Contrast Dose ◽

Single Center Experience ◽

Transcatheter Aortic Valve ◽

Over Time

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Temporal Trends and Drivers of Heart Team Utilization in Transcatheter Aortic Valve Replacement: A Population‐Based Study in Ontario, Canada

Journal of the American Heart Association ◽

10.1161/jaha.120.020741 ◽

2021 ◽

Author(s):

Gil Marcus ◽

Feng Qiu ◽

Ragavie Manoragavan ◽

Dennis T. Ko ◽

Gabby Elbaz‐Greener ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Temporal Trends ◽

Study Patient ◽

Heart Team ◽

Transcatheter Aortic Valve ◽

Billing Code ◽

Over Time

Background The multidisciplinary Heart Team (HT) is recommended for management decisions for transcatheter aortic valve replacement (TAVR) candidates, and during TAVR procedures. Empiric evidence to support these recommendations is limited. We aimed to explore temporal trends, drivers, and outcomes associated with HT utilization. Methods and Results TAVR candidates were identified in Ontario, Canada, from April 1, 2012 to March 31, 2019. The HT was defined as having a billing code for both a cardiologist and cardiac surgeon during the referral period. The procedural team was defined as a billing code during the TAVR procedure. Hierarchical logistical models were used to determine the drivers of HT. Median odds ratios were calculated to quantify the degree of variation among hospitals. Of 10 412 patients referred for TAVR consideration, 5489 (52.7%) patients underwent a HT during the referral period, with substantial range between hospitals (median odds ratio of 1.78). Utilization of a HT for TAVR referrals declined from 69.9% to 41.1% over the years of the study. Patient characteristics such as older age, frailty and dementia, and hospital characteristics including TAVR program size, were found associated with lower HT utilization. In TAVR procedures, the procedural team included both cardiologists and cardiac surgeons in 94.9% of cases, with minimal variation over time or between hospitals. Conclusions There has been substantial decline in HT utilization for TAVR candidates over time. In addition, maturity of TAVR programs was associated with lower HT utilization.

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Trends in the use of mechanical and bioprosthetic aortic valve replacement in the era of transcatheter aortic valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehab724.1582 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Hiltner ◽

I Erinne ◽

A Singh ◽

M Russo ◽

C Chen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Age Groups ◽

Inpatient Mortality ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Over Time

Abstract Background The choice between a mechanical versus a bioprosthetic valve in aortic valve replacement (AVR) is based on life expectancy, bleeding risk and co-morbidities, since bioprosthetic AVR (bAVR) as compared to mechanical AVR (mAVR), are associated with a more rapid structural deterioration. However, refinements in bioprosthetic valves and the introduction of transcatheter aortic valve replacement (TAVR) (potential for valve-in-valve procedures), will most likely influence valve selection in the future. The impact of widespread transcatheter valve replacements, on the decision to use bAVR versus mAVR, in the contemporary era and subsequent outcomes remain to be determined. Purpose The goal of our study was to assess trends in utilization of bAVR and mAVR in the United States while, assessing in-hospital mortality over time. Methods The National Inpatient database (2009–18) was used to study trends in admissions for bAVR and mAVR and in-hospital mortality over time. Survey estimation commands were used to determine weighted national estimates. Results There were 700,896 inpatient visits for AVR with 70.1% (95% CI 69.2%-71.1%) and 29.9% (95% CI 28.9%-30.8%) visits for bAVR and mAVR, respectively. Those undergoing bAVR were significantly older, [bAVR (69.8 years) vs mAVR (62.7 years) p<0.001]. Heart failure, cardiac arrhythmias, hypertension, diabetes with complications and renal failure were more common in those undergoing a bAVR. Through the course of the study period, the rates of mAVR decreased across all age groups (p trend <0.001), including patients younger than 50 years (p trend <0.001). Both crude (OR = 1.20 95% CI 1.13–1.27) and adjusted (OR = 1.34 95% CI 1.25–1.44) inpatient mortality was higher amongst mAVR recipients. Conclusions In the contemporary TAVR era, the utilization of mAVR has decreased across all age groups, including those younger than 50 years old. Although mAVR recipients were healthier with significantly less co-morbidities, inpatient mortality was higher after mAVR compared to bAVR. In addition to understanding the causes accounting for the higher mortality after mAVR, future research should focus on developing TAVR friendly bAVR; possibly enhancing our ability to perform percutaneous valve-in-valve procedures in the future. FUNDunding Acknowledgement Type of funding sources: None.

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