Comparison of Hospital Outcome of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes Mellitus (from the Nationwide Inpatient Sample)

Ando, Tomo; Akintoye, Emmanuel; Telila, Tesfaye; Briasoulis, Αlexandros; Takagi, Hisato; Slovut, David P.; Schreiber, Theodore; Grines, Cindy L.; Afonso, Luís

doi:10.1016/j.amjcard.2016.12.026

Cited by 13 publications

(10 citation statements)

References 16 publications

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“…In cases undergoing SAVR, T2DM patients were found to have lower mortality than non-diabetic patients. These results differ from those reported by other authors who have found an increase in mortality in T2DM patients who underwent SAVR [ 14 ]. Despite an overall lower mortality in patients with DM, those diabetics undergoing SAVR had a higher mortality than diabetics undergoing TAVI.…”

Section: Discussioncontrasting

confidence: 99%

“…Despite an overall lower mortality in patients with DM, those diabetics undergoing SAVR had a higher mortality than diabetics undergoing TAVI. Ando et al [ 14 ], in a recent study, demonstrated that diabetic patients with aortic stenosis undergoing TAVI (n = 5719) had lower in–hospital mortality compared to those undergoing open surgical replacement (N = 65,096). The lower in-hospital mortality in T2DM patients undergoing SAVR compared to non-diabetics might be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

“…Type 2 Diabetes mellitus is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions [ 10 , 11 ]. How T2DM might influence the treatment of AS has not been completely elucidated for SAVR or TAVI [ 9 , 12 – 14 ]. In addition, the conflicting results of published clinical trials and multicenter studies led to the current research.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014–2015)

Méndez‐Bailón

Lorenzo-Villalba²,

Muñoz‐Rivas

et al. 2017

Cardiovasc Diabetol

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BackgroundType 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures.MethodsWe analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS).ResultsWe identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR).ConclusionsT2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed.Electronic supplementary materialThe online version of this article (10.1186/s12933-017-0631-6) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014–2015)

Méndez‐Bailón

Lorenzo-Villalba²,

Muñoz‐Rivas

et al. 2017

Cardiovasc Diabetol

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“…A recent study performed on 254 DM patients compared to 548 non-DM individuals undergoing TAVI showed that this procedure is not associated with an increased risk of short-term complications or mortality [77]. Similarly, Ando et al [78] in a large cohort study performed on 70 815 AS patients showed that all-cause mortality in diabetic patients treated with TAVI was 2.8% compared to 3.6% in the SAVR group. Notably, a randomized trial performed on 586 AS patients treated with TAVI showed no difference in 30-day mortality between DM and non-DM patients [79].…”

Section: Practical Implicationsmentioning

confidence: 94%

Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications

Natorska

2021

Kardiol Pol

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“…13 Some estimates indicate that a hospital's direct costs of the TAVR index hospitalization are statistically significantly higher than SAVR in the United States ($50K vs $45K). 14,22 However, in certain subpopulations, TAVR is shown to be more economical than SAVR, as is the case in chronic obstructive pulmonary disease ($56.1K vs $63.1K), 23 diabetes mellitus ($58.9K vs $63.9K), 24 and chronic kidney disease stage IV and above ($58.9K vs $62.3K). 25 Materials.…”

Section: Costmentioning

confidence: 99%

Analysis of the Changing Economics of US Hospital Transcatheter Aortic Valve Replacement Programs

Kumar

Sandhu

Harper

et al. 2021

Mayo Clinic Proceedings

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New technologies in medicine, even if they are promising medically, are often expensive and logistically difficult to implement at the hospital level. Transcatheter aortic valve replacement (TAVR) is a model technology that is revolutionary in treating aortic stenosis, but has been plagued with significant challenges with financial sustainability. In this article, a margin analysis at the hospital level was performed using literature data. A TAVR industry analysis was performed using Porter's Five Forces framework. The data indicate that TAVR is more expensive than surgical aortic valve replacement, although the cost of TAVR is declining with the use of an optimized minimalist protocol. The overall industry is growing as its clinical indications expand, and it will likely undergo significant reduction of costs when new valves enter the US market. As such, TAVR is a growing industry, with financial sustainability currently dependent on operational efficiency. A concluding list of specific program interventions is provided to help TAVR programs improve operational efficiency and clinical outcomes, as well as help decide whether to create, expand, or redirect funding for TAVR programs. Importantly, the frameworks used to analyze this rapidly evolving technology can be applied to other new technologies to determine financial sustainability.

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Comparison of Hospital Outcome of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes Mellitus (from the Nationwide Inpatient Sample)

Cited by 13 publications

References 16 publications

Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014–2015)

Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014–2015)

Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications

Analysis of the Changing Economics of US Hospital Transcatheter Aortic Valve Replacement Programs

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