In-hospital outcomes of transcatheter aortic valve replacement (TAVR) in patients with localized and metastatic malignancy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18602-e18602
Author(s):  
Hugo Macchi ◽  
Miguel Salazar ◽  
Juan Del Cid Fratti ◽  
Estefania Gauto ◽  
Binav Baral ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Metastatic Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Private Insurance ◽  
Total Hospital Cost ◽  
Short Term ◽  
Transcatheter Aortic Valve ◽  
Procedural Complications

e18602 Background: There is limited use of transcatheter aortic valve replacement (TAVR) in patients with malignancy, given that current guidelines do not recommend TAVR in patients with a life expectancy of less than 1 year. Data that compare short-term outcomes after TAVR in cancer and metastasis is scarce. Methods: Using the national inpatient sample (NIS) database, we identified patients who underwent TAVR from 2016-2017 using ICD10-PCS codes. Patients were subsequently divided based on local malignancy and metastatic malignancy. In-hospital mortality, total hospital cost, length of hospital stays, and post-procedural complications were evaluated. Multivariate logistic regression analysis was conducted to adjust for confounders. Results: A total of 91, 624 TAVR hospitalizations were identified, 4, 995 (4.7%) with malignancy. Patients with malignancy were most likely to be women, have a higher Charlson comorbidity index, to use private insurance, and being admitted to a teaching hospital. The most common malignancy was hematological, head and neck, prostate, digestive, and breast cancer of these patients 15.6% had metastatic disease at the time of TAVR. After adjusting for confounders there was no difference in mortality, LOS, healthcare utilization, and post-procedural complications. Conclusions: TAVR seems to have a safe short-term outcome in patients with active malignancy and metastatic disease. In this population, we recommend having an oncological evaluation to perform a risk assessment to aid in the decision when to not proceed with TAVR.[Table: see text]

Abstract 17027: Racial Disparities in Transcatheter Aortic Valve Replacement Access: Geographic Analysis Suggesting Disparate Access to Care

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Nidal Ganim ◽  
Dominique J Monlezun ◽  
Enrique D Garcia-Sayan ◽  
Prakash Balan
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Racial Disparities ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Private Insurance ◽  
High Volume ◽  
Racial Minorities ◽  
Transcatheter Aortic Valve ◽  
Excess Costs

Background: Transcatheter aortic valve replacement (TAVR) has ample randomized trial evidence that it can reduce mortality and cost for patients with aortic stenosis. Yet racial disparities in procedure access are poorly understood. Methods: This case-control prospectively enrolled TAVR subjects at a single high-volume quaternary academic medical center in Houston, Texas, USA, from 11/8/11-3/28/18. Neural network machine learning-supported binomial probability testing was conducted comparing the Houston population versus the center’s TAVR rates by race, with mortality and cost extrapolations. The IOM definition of health inequities was applied using the rank and replace method for counterfactual comparison (matching subjects by insurance and Society of Thoracic Surgery [STS] risk score for TAVR eligibility). Results: Compared to the Houston population, TAVR subjects (N=1641) were significantly more likely to be Caucasians (51.93% vs 77.26%), and less likely to be African Americans (14.80% vs 6.02%), Hispanics (23.63% vs 15.02%), or other races (9.50% vs 1.70%), all p<0.001. Among TAVR subjects with private insurance, the large majority were Caucasian (832, 85.60%), with the minority being African American (34, 3.50%), Hispanic (96, 9.88%), and other (10, 37.04%) (private insurance by Caucasian versus non-Caucasian, p<0.001). Based on TAVR mortality and cost savings in the PARNTER trial, access disparities for racial minorities over 5 years may result in 858 excess deaths, $130,000 per patient excess costs, and $111.5 million excess costs per the overall sample of eligible presenting Houston subjects. The predicted versus actual racial distribution of TAVR for each minority group matched to Caucasians by insurance and STS score was significantly greater than the actual (each group comparison to Caucasians, p<0.001). Conclusion: Multi-year data from our high-volume center suggest Houston racial minorities are less likely to undergo TAVR, potentially translating into a growing number of preventable excess early deaths and costs as disease incidence increases. Additional studies are underway to determine and reduce the degree of preventable race-related disparities independent of known access predictors.

scholarly journals Incidence, Predictor, and Clinical Outcomes of Multiple Resheathing With Self‐Expanding Valves During Transcatheter Aortic Valve Replacement

2021 ◽  
Author(s):  
Fernando L. M. Bernardi ◽  
Josep Rodés‐Cabau ◽  
Gabriela Tirado‐Conte ◽  
Ignacio J. Amat Santos ◽  
Claudia Plachtzik ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Regurgitation ◽  
Transcatheter Aortic Valve ◽  
Device Embolization ◽  
Procedural Complications ◽  
The Impact ◽  
Mortality Hazard Ratio

Background No study has evaluated the impact of the additional manipulation demanded by multiple resheathing (MR) in patients undergoing transcatheter aortic valve replacement with repositionable self‐expanding valves. Methods and Results This study included a real‐world, multicenter registry involving 16 centers from Canada, Germany, Latin America, and Spain. All consecutive patients who underwent transcatheter aortic valve replacement with the Evolut R, Evolut PRO, and Portico valves were included. Patients were divided according to the number of resheathing: no resheathing, single resheathing (SR), and MR. The primary end point was device success. Secondary outcomes included procedural complications, early safety events, and 1‐year mortality. In 1026 patients, the proportion who required SR and MR was 23.9% and 9.3%, respectively. MR was predicted by the use of Portico and moderate/severe aortic regurgitation at baseline (both with P <0.01). Patients undergoing MR had less device success (no resheathing=89.9%, SR=89.8%, and MR=80%; P =0.01), driven by more need for a second prosthesis and device embolization. At 30 days, there were no differences in safety events. At 1 year, more deaths occurred with MR (no resheathing=10.5%, SR=8.0%, and MR=18.8%; P =0.014). After adjusting for baseline differences and center experience by annual volume, MR associated with less device success (odds ratio, 0.42; P =0.003) and increased 1‐year mortality (hazard ratio, 2.06; P =0.01). When including only the Evolut R/PRO cases (N=837), MR continued to have less device success ( P <0.001) and a trend toward increased mortality ( P =0.05). Conclusions Repositioning a self‐expanding valve is used in a third of patients, being multiple in ≈10%. MR, but not SR, was associated with more device failure and higher 1‐year mortality, regardless of the type of valve implanted.

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