“KEEPING THEM AWAKE DOES IT MATTER?” PREDICTORS OF PROLONGED LENGTH OF STAY FOLLOWING TRANSCUTANEOUS AORTIC VALVE REPLACEMENT

2018 ◽  
Vol 71 (11) ◽  
pp. A1226
Author(s):  
Upamanyu Rampal ◽  
Rahul Vasudev ◽  
Hiten Patel ◽  
Salvatore M. Zisa ◽  
Habib Habib ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prolonged Length

Abstract 064: Improving Aortic Valve Replacement Risk Prediction: The Role of Geographically Derived Socioeconomic Factors

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Fenton H McCarthy ◽  
Lingjao Zhang ◽  
Jingbo Che ◽  
Desmond Graves ◽  
W. Clark Hargrove ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Risk Prediction ◽  
Area Under The Curve ◽  
Census Tracts ◽  
Census Tract Level ◽  
Level Data ◽  
Multivariable Models

Objective: Low socioeconomic status (SES) is associated with worse surgical outcomes. Current risk adjustment models for aortic valve replacement (AVR) surgery do not include (SES), and therefore centers that treat large numbers of low-SES patients may be disadvantaged in hospital outcomes comparisons. This study evaluates whether inclusion of SES improves AVR risk prediction models. Methods: All patients undergoing isolated aortic valve replacement (AVR) at a single institution from 2005-2015 were evaluated. We estimated patients’ SES using census-tract-level data, which are more precise than ZIP-code-level data. We excluded patients (~5%) with addresses that could not be geolocated to census tracts. SES covariates were available for 95% of the study population. SES measures included mean rates of unemployment, poverty, household income, home value, educational attainment, and housing density. The risk scores for mortality, complications and increased length of stay were generated using models published by the Society for Thoracic Surgeons. Univariate models were fitted for each SE covariate with a cut-off of p <0.2 for inclusion in the multivariable models for (a) mortality, (b) any complication, and (c) prolonged length of stay (PLOS) in addition to the expected risk. We evaluated the incremental value of SES covariates using area under the curve (AUC). Results: Amongst the 1,386 patients undergoing AVR included in the study, the overall mortality was 2.8%, any complication rate was 15.1% and PLOS was 9.7%. In univariate models, higher education quartile was associated with decreased mortality (OR 0.96, p = 0.04) and complications (OR 0.97, p <0.01). Poverty was associated with increased length of stay (LOS) (OR 1.02, p =0.02). In the multivariable models, the inclusion of SES covariates increased the area under the curve (AUC) for mortality (0.735 to 0.750, p=0.14), for any complications (0.663 to 0.680, p<0.01), and for PLOS (0.749 to 0.751, p=.12) Conclusions: The inclusion of census-tract-level socioeconomic factors into the STS risk predication models is new and shows potential to improve risk prediction for outcomes following AVR, particularly for predictions of any complications following AVR. With the possibility of reimbursement and institutional ranking based on these outcomes, this study represents an improvement in risk predication model even when limited to census tracts and a single institution’s experience.

Abstract 18807: Use of Mechanical Circulatory Support and Transcatheter Aortic Valve Replacement (TAVR): Insights From Nationwide Inpatient Sample

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Samir V Patel ◽  
Vikas Singh ◽  
Chirag Savani ◽  
Rajesh Sonani ◽  
sidakpal S Panaich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Mechanical Circulatory Support ◽  
Nationwide Inpatient Sample ◽  
Circulatory Support ◽  
Transcatheter Aortic Valve

Introduction: Short-term use of Mechanical Circulatory Support (MCS) has the potential to benefit the patients undergoing Transcatheter Aortic Valve Replacement (TAVR) who may be high-risk or suffer complications. The present study was conducted to address the contemporary use of MCS in TAVR procedures. Methods: The study included a total of 1794 TAVR procedures in the years 2011-2012 from Nationwide Inpatient Sample (NIS) database. Use of MCS was identified using ICD-9-CM codes. The patients were divided based on use of MCS devices. The primary outcome of the study was in-hospital mortality and the secondary outcomes were complications, length of stay (LOS) and cost. Multi-variate simple logistic regression models were used to identify independent predictors of the outcomes. Results: Out of total 1794 TAVR procedures, 190 (10.6 %) utilized a MCS device (MCS group) and 1,604 (89.4%) did not (non-MCS group). The use of MCS devices with TAVR was associated with increase in the in-hospital mortality (14.9% vs. 3.5%, p<0.01) with same results obtained in multi-variate models. The rates of complications were significantly higher in MCS group so as the mean length of stay (11.8±0.8 vs. 8.1±0.2 days, p<0.01) and cost ($68,997±3,656 vs. $55,878±653, p=0.03). Conclusion: Use of MCS in TAVR predicts increase in-hospital mortality, complications, LOS and cost of care.

Abstract 14906: Predictors and Outcome Impact of Mitral Regurgitation in Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Giorgio A Medranda ◽  
Kunal Brahmbhatt ◽  
Khaled Salhab ◽  
Richard K Schwartz ◽  
Stephen Green
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Unit Length ◽  
Risk Groups ◽  
Term Outcome ◽  
Transcatheter Aortic Valve

Background: Mitral regurgitation (MR) frequently accompanies aortic stenosis (AS). Several studies have reported that certain patients see improvement in their MR following transcatheter aortic valve replacement (TAVR) alone using earlier generation valves. The purpose of this study was to determine the predictors and short-term outcome impact of MR in patients undergoing TAVR using all generation valves across all risk groups. Methods: In this retrospective, study from 2012-2019, we reviewed data on 1,626 low, intermediate and high-risk patients who underwent TAVR. Included were patients with baseline MR who underwent transfemoral TAVR. We excluded prior valve replacement and aborted TAVR. Our primary outcome was persistence or worsening of baseline MR post-TAVR. Additional endpoints included an inpatient composite (intensive care unit length of stay >24 hours, post-TAVR length of stay >2 days and inpatient death), 30-day composite (30-day death or 30-day readmission) and 1-year composite (1-year death or readmission). Results: Of the 1,626 patients screened, 552 had significant baseline MR (>moderate), which improved in 79.7% of patients. Female patients, those with higher right ventricular systolic pressures and those who underwent TAVR using earlier generation valves were more likely to have persistence or worsening of significant baseline MR. Patients whose significant baseline MR (>moderate) persisted or worsened, had higher rates (92.2 vs. 84.1%, p=0.0343) of our inpatient composite and higher rates (36.6% vs. 25.5%, p=0.0243) of our 1-year composite when compared to patients whose significant baseline MR (>moderate) improved post-TAVR. Conclusions: Our study identifies certain clinical characteristics, which could help identify the subset of patients who may require closer post-procedural follow-up and warrant possible staged mitral valve intervention post-TAVR across all risk groups.

Minimal-Access Aortic Valve Replacement with Concomitant Aortic Procedure: A 9-Year Experience

2012 ◽  
Vol 7 (5) ◽  
pp. 368-371 ◽  
Author(s):  
Tsuyoshi Kaneko ◽  
Gregory S. Couper ◽  
Wernard A.A. Borstlap ◽  
Foeke J.H. Nauta ◽  
Laurens Wollersheim ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Morbidity Rate ◽  
Minimal Access ◽  
True Aneurysm ◽  
Aortic Replacement

Objective Minimal-access approaches through upper hemisternotomy is an established technique for aortic valve replacement (AVR) and aortic surgery in our institution. We assessed the outcome of undergoing AVR with concomitant aortic surgery through upper hemisternotomy. Methods We retrospectively reviewed 109 patients from January 2002 to May 2011 who had AVR with concomitant aortic surgery through upper hemisternotomy. Aortic valve replacement with supra-coronary ascending aortic replacement was performed in 65 patients; AVR with ascending and proximal arch replacement, in 8 patients; AVR with aortoplasty, in 11 patients; Bentall procedure, in 8 patients; and AVR with root enlargement, in 13 patients. In-hospital outcomes and 1- and 5-year survival were examined. Results The mean age was 58.5 years (range, 23–89 years); 41.3% of patients had bicuspid aortic valve (n = 45). Of the patients, 82.6% had true aneurysm (n = 90), 2.8% had calcified aorta (n = 3), 8.3% had small annulus (n = 9), and 3.7% had calcified annulus (n = 4). There were 6 (5.5%) reoperations and 15 (13.8%) urgent cases. Mean perfusion time was 152 ± 61 minutes, and cross-clamp time was 108 ± 47 minutes. Nine cases were performed with deep hypothermic circulatory arrest (8.3%). Operative mortality was 2.8% (n = 3). There were 4 (3.7%) cases with reoperation for bleeding, 2 (1.8%) myocardial infarctions, and 2 (1.8%) new-onset renal failure. Mean length of stay was 7.1 ± 5.6 days. Kaplan-Meier analysis showed that 1-year postoperative survival was 96.2% and 5-year survival was 92.4%. Conclusions An upper hemisternotomy approach is safe and feasible for AVR and concomitant aortic surgery with good early and midterm outcomes. This approach is also associated with low morbidity rate and short length of stay.

Management of large bore access complications in the era of trans-catheter aortic valve replacement

Vascular ◽  
2020 ◽  
pp. 170853812096946
Author(s):  
Michael H Parker ◽  
Dipankar Mukherjee ◽  
Liam Ryan
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Care Center ◽  
Tertiary Care ◽  
Vascular Complications ◽  
Femoral Access ◽  
Arterial Complications ◽  
Valvular Stenosis

Objectives Trans-catheter aortic valve replacement is a commonplace procedure for patients with aortic valvular stenosis who are at a high risk for surgery, evidenced by the 34,892 trans-catheter aortic valve replacements performed in 2016. Trans-catheter aortic valve replacement’s rate of major vascular complications with second-generation closure devices is 4.5% according to a meta-analysis of 10,822 patients. To manage those complications, percutaneous approaches to arterial repairs show shorter length of stay, higher rate of direct to home discharge and equivalent outcomes at long-term follow-up. This study’s goal is to show that one center’s vascular access strategy can decrease open repairs and improve patient outcomes. Methods Our team began accessing the mid-common femoral artery at least 1–2 cm proximal to the takeoff of the profunda femoris. This allowed an endovascular stent to be deployed if necessary via contralateral femoral access. We performed a completion angiogram following every trans-catheter aortic valve replacement to ensure no arterial complications. We conducted a retrospective review of a prospectively maintained database for all trans-catheter aortic valve replacement cases at a tertiary care center from 1 January 2016 to 30 June 2018. Results A total of 699 trans-catheter aortic valve replacement procedures were performed with 25/31 (80.6%) cases met inclusion criteria. An increase was noted in the number of stent procedures versus cutdown procedures over time ( P < 0.001). A decrease was noted in the number of vascular surgery team activations following trans-catheter aortic valve replacement ( P = 0.004). A non-significant trend was noted toward a shorter median length of stay for the stent group ( P = 0.149). There was no increase in 30-day mortality rate (0.0% for both groups) or 30-day readmissions (4/15 (26.7%) for stents vs. 2/10 (20.0%) for open repairs; P > 0.999). Conclusions This strategy is safe and feasible to implement and reduces the number of open repairs following trans-catheter aortic valve replacement, activation of surgical resources, and possibly the length of stay.

Acute Heart Failure at the Time of Transcatheter Aortic Valve Replacement Does not Increase Mortality

2018 ◽  
Vol 13 (1) ◽  
pp. 47-50 ◽  
Author(s):  
William T. Burke ◽  
Jaimin R. Trivedi ◽  
Michael P. Flaherty ◽  
Kendra J. Grubb
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Natriuretic Peptide ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Objective Patients presenting for transcatheter aortic valve replacement are often in acute on chronic heart failure, as indicated by elevated N-terminal pro-B-type natriuretic peptide. Many believe that elevated N-terminal pro-B-type natriuretic peptide is an indication to treat medically, reserving surgery until the patient is medically optimized. Methods A single-center transcatheter aortic valve replacement database was queried from December 2015 to November 2016 to identify patients undergoing transcatheter aortic valve replacement. Patients were divided into two cohorts based on preoperative N-terminal pro-B-type natriuretic peptide level. An analysis was then completed to assess outcomes such as length of intensive care unit stay, total length of stay, discharge to home, major complications, and mortality at 30 days. Results There were 142 patients (median age = 80 years, 44% female) with preoperative N-terminal pro-B-type natriuretic peptide data included (range = 106–73,500 pg/mL). The mean Society of Thoracic Surgeons predicative risk of mortality was 8%, and 46 patients (32%) had N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL. N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL was associated only with increased intensive care unit length of stay of greater than 24 hours (35% vs 9%, P = 0.0001). There was no statistical difference between cohorts with regard to total length of stay of greater than 3 days (24% vs 15%, P = 0.2), discharge to home (74% vs 83%, P = 0.3), major complication, or mortality at 30 days. Conclusions Transcatheter aortic valve replacement is an appropriate and effective treatment for patients with aortic stenosis presenting with high N-terminal pro-B-type natriuretic peptide and acute on chronic heart failure.

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