Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation
| Autor: | Musab Alqasrawi, Alexander C. Egbe, Amgad Mentias, Oluwole Adegbala, Milind Y. Desai, Luis Afonso, Alexandros Briasoulis, Tomo Ando, Aubin Sandio, Mohamed Salih, Abdullahi Oseni, Emmanuel Akintoye, Sidakpal S. Panaich, Phanicharan Sistla, Josiah Zubairu |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Pacemaker Artificial Transcatheter aortic Databases Factual medicine.medical_treatment 030204 cardiovascular system & hematology Annual change Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Aortic valve replacement Internal medicine Medicine Humans National level 030212 general & internal medicine Hospital Mortality Aged Aged 80 and over Heart Valve Prosthesis Implantation business.industry Aortic Valve Stenosis Acute Kidney Injury Length of Stay medicine.disease United States Clinical trial Stroke Stenosis Aortic Valve Mixed effects Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The American journal of cardiology. 126 |
| ISSN: | 1879-1913 |
| Popis: | Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome. |
| Databáze: | OpenAIRE |
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