scholarly journals Transcatheter Aortic Valve Replacement in Low-Population Density Areas

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Abdulla A. Damluji ◽  
Michael Fabbro ◽  
Richard H. Epstein ◽  
Stefan Rayer ◽  
Ying Wang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Population Density ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Travel Time ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Healthcare Access ◽  
Transcatheter Aortic Valve ◽  
Trade Offs

Background: Restricting transcatheter aortic valve replacement (TAVR) to centers based on volume thresholds alone can potentially create unintended disparities in healthcare access. We aimed to compare the influence of population density in state of Florida in regard to access to TAVR, TAVR utilization rates, and in-hospital mortality. Methods and Results: From 2011 to 2016, we used data from the Agency for Health Care Administration to calculate travel time and distance for each TAVR patient by comparing their home address to their TAVR facility ZIP code. Travel time and distance, TAVR rates, and mortality were compared across categories of low to high population density (population per square miles of land). Of the 6531 patients included, the mean (SD) age was 82 (9) years, 43% were female and 91% were White. Patients residing in the lowest category (<50/square miles) were younger, more likely to be men, and less likely to be a racial minority. Those residing in the lowest category density faced a longer unadjusted driving distances and times to their TAVR center (mean extra distance [miles]=43.5 [95% CI, 35.6–51.4]; P <0.001; mean extra time (minutes)=45.6 [95% CI, 38.3–52.9], P <0.001). This association persisted regardless of the methods used to determine population density. Excluding uninhabitable land, there was a 7-fold difference in TAVR utilization rates in the lowest versus highest population density regions (7 versus 45 per 100 000, P -for-pairwise-comparisons <0.001) and increase in TAVR in-hospital mortality (adjusted OR, 6.13 [95% CI, 1.97–19.1]; P <0.001). Conclusions: Older patients living in rural counties in Florida face (1) significantly longer travel distances and times for TAVR, (2) lower TAVR utilization rates, and (3) higher adjusted TAVR mortality. These findings suggest that there are trade-offs between access to TAVR, its rate of utilization, and procedural mortality, all of which are important considerations when defining institutional and operator requirements for TAVR across the country.

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 120 (11) ◽  
pp. 1580-1586 ◽  
Author(s):  
Achim Lother ◽  
Klaus Kaier ◽  
Ingo Ahrens ◽  
Wolfgang Bothe ◽  
Dennis Wolf ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bleeding Complications ◽  
Hospital Outcome ◽  
Transcatheter Aortic Valve

Abstract Background Atrial fibrillation (AF) is a risk factor for poor postoperative outcome after transfemoral transcatheter aortic valve replacement (TF-TAVR). The present study analyses the outcomes after TF-TAVR in patients with or without AF and identifies independent predictors for in-hospital mortality in clinical practice. Methods and Results Among all 57,050 patients undergoing isolated TF-TAVR between 2008 and 2016 in Germany, 44.2% of patients (n = 25,309) had AF. Patients with AF were at higher risk for unfavorable in-hospital outcome after TAVR. Including all baseline characteristics for a risk-adjusted comparison, AF was an independent risk factor for in-hospital mortality after TAVR. Among patients with AF, EuroSCORE, New York Heart Association classification class, or renal disease had only moderate effects on mortality, while the occurrence of postprocedural stroke or moderate to major bleeding substantially increased in-hospital mortality (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.61–4.30, p < 0.001 and OR 3.12, 95% CI 2.68–3.62, p < 0.001). However, the strongest independent predictor for in-hospital mortality among patients with AF was severe bleeding (OR 18.00, 95% CI 15.22–21.30, p < 0.001). Conclusion The present study demonstrates that the incidence of bleeding defines the in-hospital outcome of patients with AF after TF-TAVR. Thus, the periprocedural phase demands particular care in bleeding prevention.

Modifiable Predictors of In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement

2018 ◽  
Vol 356 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Oluwaseun A. Akinseye ◽  
Muhammad Shahreyar ◽  
Chioma C. Nwagbara ◽  
Mannu Nayyar ◽  
Salem A. Salem ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

scholarly journals Patient-centered benefit-risk analysis of transcatheter aortic valve replacement

F1000Research ◽  
2021 ◽  
Vol 8 ◽  
pp. 394
Author(s):  
Kevin Marsh ◽  
Natalia Hawken ◽  
Ella Brookes ◽  
Carrie Kuehn ◽  
Barry Liden
Keyword(s):  
Aortic Valve ◽  
Risk Analysis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pairwise Comparison ◽  
Surgical Aortic Valve Replacement ◽  
Patient Centered ◽  
Transcatheter Aortic Valve ◽  
Trade Offs

Background: Aortic stenosis (AS) treatments include surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Choosing between SAVR and TAVR requires patients to trade-off  benefits and risks. The objective of this research was to determine which  TAVR and SAVR outcomes patients consider important, collect quantitative data about how patients weigh benefits and risks, and evaluate patients’ preferences for SAVR or TAVR. Methods: Patients  were recruited from advocacy organization databases. Patients self-reported as being diagnosed with AS, and as either having received AS treatment or as experiencing AS-related physical activity limitations. An online adapted swing weighting (ASW) method – a pairwise comparison of attributes – was used to elicit attribute trade-offs from 219 patients. Survey data were used to estimate patients’ weights for AS treatment attributes, which were incorporated into a quantitative benefit-risk analysis (BRA) to evaluate patients’ preferences for TAVR and SAVR. Results: On average, patients put greater value on attributes that favored TAVR than SAVR. Patients’ valuation of the lower mortality rate, reduced procedural invasiveness, and quicker time to return to normal quality of life associated with TAVR, offset their valuation of the time over which SAVR has been proven to work. There was substantial heterogeneity in patients’ preferences. This was partly explained by age, with differences in preference observed between patients <60 years to those ≥60 years. A Monte Carlo Simulation found that 79.5% of patients prefer TAVR. Conclusions: Most AS patients are willing to tolerate sizable increases in clinical risk in exchange for the benefits of TAVR, resulting in a large proportion of patients preferring TAVR to SAVR. Further work should be undertaken to characterize the heterogeneity in preferences for AS treatment attributes. Shared decision-making tools based on attributes important to patients can support patients’ selection of the procedure that best meets their needs.

Sex differences in mortality and 90-day readmission rates after transcatheter aortic valve replacement: a nationwide analysis from the USA

2021 ◽  
Author(s):  
Venkata S Pajjuru ◽  
Abhishek Thandra ◽  
Raviteja R Guddeti ◽  
Ryan W Walters ◽  
Aravdeep Jhand ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Readmission Rates ◽  
Logistic Regression Models ◽  
Transcatheter Aortic Valve ◽  
The Usa ◽  
Gender Based

Abstract Aims To assess gender differences in in-hospital mortality and 90-day readmission rates among patients undergoing transcatheter aortic valve replacement (TAVR) in the USA. Methods and results Hospitalizations for TAVR were retrospectively identified in the National readmissions database (NRD) from 2012 to 2017. Gender based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models. During the study period, an estimated 171 361 hospitalizations for TAVR were identified, including 79 722 (46.5%) procedures in women and 91 639 (53.5%) in men. Unadjusted in-hospital mortality and 90-day all-cause readmissions were significantly higher for women compared with men (2.7% vs. 2.3%, P = 0.002; 25.1% vs. 24.1%, P = 0.012, respectively). After adjusting for baseline characteristics, women had 13% greater adjusted odds of in-hospital mortality [adjusted odds ratio (aOR): 1.13, 95% confidence interval (CI): 1.02–1.26, P = 0.017], and 9% greater adjusted odds of 90-day readmission compared with men (aOR: 1.09, 95% CI: 1.05–1.14, P &lt; 0.001). During the study period, there was a steady decrease in-hospital mortality (5.3% in 2012 to 1.6% in 2017; Ptrend &lt; 0.001) and 90-day (29.9% in 2012 to 21.7% in 2017; Ptrend &lt; 0.001) readmission rate in both genders. Conclusion In-hospital mortality and readmission rates for TAVR hospitalizations have decreased over time across both genders. Despite these improvements, women undergoing TAVR continue to have a modestly higher in-hospital mortality, and 90-day readmission rates compared with men. Given the expanding indications and use of TAVR, further research is necessary to identify the reasons for this persistent gap and design appropriate interventions.

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.

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