A logistic regression analysis comparing minimalistic approach and intubation anaesthesia in patients undergoing transfemoral transcatheter aortic valve replacement

Abstract Objective The aim of this study is to assess the effects on procedural, 30-day, and 1‑year all-cause mortality by a newly introduced quality improvement strategy in patients after transcatheter aortic valve replacement (TAVR). Methods In October 2015, a coherent set of quality improving interventions with respect to patient geriatric screening, general diagnostic examination and safety of the procedure was implemented at a single centre in the Netherlands. Patients undergoing TAVR in 2013–2018 were included for retrospective analysis. Mortality was assessed in the pre-quality improvement strategy cohort (January 2013 to October 2015; cohort A) and in the post-quality improvement strategy cohort (November 2015 to December 2018; cohort B). Logistic regression analysis was used to estimate the influence of patient and procedural characteristics on the results of the quality improvement strategy in terms of procedural, 30-day, and 1‑year all-cause mortality. Results In total, 806 patients were analysed with 274 patients in cohort A and 532 patients in cohort B. After introduction of the quality improvement strategy, procedural (4.4% to 1.3%, p < 0.01), 30-day (8.4% to 2.7%, p < 0.01) and 1‑year (16.4% to 8.5%, p < 0.01) all-cause mortality significantly decreased. Multivariate regression analysis showed that the quality improvement strategy also significantly reduced 30-day (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.09–0.42) and 1‑year (OR 0.38, 95% CI 0.24–0.61) all-cause mortality if corrected for patient characteristics. Conclusion Structural meetings on evaluation of outcomes highlight potential areas for improvement and subsequent outcome-based quality improvement initiatives can result in lower procedural, 30-day, and 1‑year all-cause mortality.

Download Full-text

Temporal Trends in Mortality after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Regression Analysis

Structural Heart ◽

10.1080/24748706.2019.1689321 ◽

2019 ◽

Vol 4 (1) ◽

pp. 16-23 ◽

Cited By ~ 1

Author(s):

Soeren Mattke ◽

Stefan Schneider ◽

Patrick Orr ◽

Darius Lakdawalla ◽

Dana Goldman

Keyword(s):

Systematic Review ◽

Regression Analysis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Temporal Trends ◽

Transcatheter Aortic Valve ◽

Meta Regression ◽

Meta Regression Analysis

Download Full-text

Impact of new pacemaker implantation following surgical and transcatheter aortic valve replacement on 1-year outcome

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz168 ◽

2019 ◽

Vol 57 (1) ◽

pp. 151-159 ◽

Cited By ~ 7

Author(s):

Buntaro Fujita ◽

Tobias Schmidt ◽

Sabine Bleiziffer ◽

Timm Bauer ◽

Andreas Beckmann ◽

...

Keyword(s):

Regression Analysis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Cox Regression ◽

Pacemaker Implantation ◽

Surgical Aortic Valve Replacement ◽

Cox Regression Analysis ◽

Transcatheter Aortic Valve

Abstract OBJECTIVES The purpose of this study was to evaluate the incidence of new pacemaker implantation (NPMI) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), and investigate its influence on 1-year mortality. METHODS Patients who were enrolled in ‘The German Aortic Valve Registry’ undergoing isolated TAVR or SAVR between 2011 and 2015 were analysed. The rate of NPMI was analysed for both groups and multivariable Cox regression analysis was performed to investigate the possible independent association between NPMI and 1-year mortality. RESULTS Twenty thousand eight hundred and seventy-two patients who underwent TAVR and 17 750 patients who received SAVR were included in this study. The rate of NPMI was 16.6% after TAVR and 3.6% after SAVR. In the TAVR group, NPMI was associated with significantly increased 1-year mortality in univariable Cox regression analysis [hazard ratio (HR) 1.29, confidence interval (CI) 1.18–1.41; P < 0.001]. This association persisted after adjustment for confounding factors (HR 1.29, CI 1.16–1.43; P < 0.001). In the SAVR group, NPMI significantly increased 1-year mortality in univariable analysis as well (HR 1.55, CI 1.08–2.22; P = 0.02), whereas after multivariable adjustment, NPMI did not emerge as an independent risk factor (HR 1.29, 0.88–1.89; P = 0.19). NPMI was not associated with 30-day mortality in both procedure groups. CONCLUSIONS The rate of NPMI was markedly higher after TAVR compared with SAVR and was independently associated with 1-year mortality after TAVR, whereas this was not significant after SAVR. As 30-day mortality was not different for TAVR and SAVR, the subsequent procedure of an NPMI itself seems not to increase the risk of mortality.

Download Full-text