Propensity Score Matched Analysis of Mechanical vs. Bioprosthetic Valve Replacement in Patients With Previous Stroke

Chen, Shaowei; Wu, Victor Chien‐Chia; Lin, Yu‐Sheng; Chen, Ching-Chang; Chen, Dong‐Yi; Chang, Chih‐Hsiang; Chu, Pao‐Hsien; Ting, Pei‐Chi; Chou, An‐Hsun; Chen, Tien-Hsing

doi:10.1253/circj.cj-18-0003

Cited by 8 publications

(6 citation statements)

References 23 publications

(16 reference statements)

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“…The medical costs of all lifesaving treatments, including cardiac surgeries for type A/B AAD, endovascular stent therapy for type B AAD, and perioperative blood transfusion, are reimbursed by the NHI. Numerous studies using data from the NHIRD for analysis have been published [8][9][10][11]. In the NHIRD, disease diagnoses are coded based on the International Classification of Diseases, 9 th Revision, Clinical Modification (ICD-9-CD).…”

Section: Data Sourcementioning

confidence: 99%

Sex-related differences on the risks of in-hospital and late outcomes after acute aortic dissection: A nationwide population-based cohort study

et al. 2022

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Objective The aim of this study is to evaluate the sex-related differences on the risks of perioperative and late outcomes for adult acute aortic dissection (AAD) patients following surgical management. Methods and results By using Taiwan National Health Insurance Research Database, totally 1,410 female and 3,432 male patients were identified to first-ever receive type A AAD open surgery or type B AAD stenting treatment from 2004 to 2013. We assessed the sex-related difference on outcomes, including in-hospital mortality, all-cause mortality, aortic death, redo aortic surgery, ischemic stroke, and depression during the follow-up period. The analysis was done separately for type A and type B surgeries. Results On average, female patients diagnosed with AAD were older than males. There was no significant sex difference of in-hospital mortality or all-cause mortality for both type A open and type B stent surgeries. The risk of redo aortic surgery was significantly greater in males than females (7.8% vs. 4%; unadjusted subdistribution hazard ratio [SHR] 0.51, 95% CI 0.38–0.69) for type A open surgery, but not for type B stent surgery. Noticeably, the risk of newly-diagnosed depression was significantly greater in females than males (8% vs. 5.1%; unadjusted SHR 1.6, 95% CI 1.24–2.06) for type A open surgery, but not for type B stent surgery. Conclusions No significant sex-related difference was found for the in-hospital mortality or accumulative all-cause mortality. However, there were more redo aortic surgeries for males and more postoperative depression for females in type A AAD population.

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Section: Data Sourcementioning

confidence: 99%

Sex-related differences on the risks of in-hospital and late outcomes after acute aortic dissection: A nationwide population-based cohort study

et al. 2022

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“…Previous cardiac surgery, surgical details and concomitant surgeries were detected using the Taiwan NHI reimbursement codes from the inpatient claims data. The type of valve surgery was identified using ICD-9-CM procedural codes (online supplemental table 2) [12][13][14] Outcomes Outcomes included both in-hospital (perioperative) complications and late outcomes. In-hospital outcomes were in-hospital mortality, new-onset stroke and newonset dialysis during the admission for the index surgery.…”

Section: Comorbiditiesmentioning

confidence: 99%

Sex differences in risks of in-hospital and late outcomes after cardiac surgery: a nationwide population-based cohort study

et al. 2022

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ObjectivesOutcomes of sex differences in major cardiac surgery remain controversial. A comprehensive understanding of sex differences in major adult cardiac surgery could provide better knowledge of risk factors, management strategy and short-term or long-term outcomes. The present study aimed to investigate sex differences in the risks of outcomes of major cardiac surgeries and subgroup analyses of different valve types.DesignPopulation-based nationwide cohort study.SettingData were obtained from National Health Insurance Research Database (NHIRD) in Taiwan.ParticipantsA total of 66 326 adult patients (age ≥20 years; 30.3% women) who underwent a first major cardiac surgery (isolated coronary artery bypass graft (CABG), isolated valve or concomitant bypass/valve) from 2000 to 2013 were identified via Taiwan NHIRD.Main outcome measuresOutcomes of primary interest were in-hospital death and all-cause mortality during follow-up period. Propensity score matching was conducted as a secondary analysis for the sensitivity test.ResultsWomen who underwent isolated CABG tended to have greater risks of both in-hospital (OR 1.37; 95% CI 1.26 to 1.49) and late outcomes (HR 1.26; 95% CI 1.22 to 1.31). Women after concomitant CABG/valve also had a greater in-hospital (OR 1.19; 95% CI 1.01 to 1.40) and long-term mortality (HR 1.14; 95% CI 1.05 to 1.24). Women after isolated mitral valve repair have a non-favourable outcome of in-hospital mortality (OR 1.70; 95% CI 1.01 to 2.87). Women who did not receive an isolated aortic valve replacement had more favourable all-cause mortality outcome (HR 0.90; 95% CI 0.84 to 0.96). Secondary analysis in the propensity score-matching cohort demonstrated results similar to the primary analysis.ConclusionsFemale patients who underwent procedures involving CABG (with or without concurrent valvular intervention) had generally worse outcomes. However, the results of isolated valve surgery were variable on the basis of the type of intervened valve.

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“…In Taiwan, the costs of all lifesaving procedures, surgeries, medical treatments and medications were reimbursed in the NHIRD, such as use of ECMO, cardiac surgery and blood transfusion. [10][11][12][13] study population This retrospective, population-based cohort study compared the outcomes between patients who did and did not receive MBT during ECMO support. MBT was defined as RBC transfusion of ≥10 units within a 1 month period since the application of ECMO.…”

Section: Data Sourcementioning

confidence: 99%

Impact of massive blood transfusion during adult extracorporeal membrane oxygenation support on long-term outcomes: a nationwide cohort study in Taiwan

Chen

et al. 2020

BMJ Open

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ObjectivesBleeding is a common problem during adult extracorporeal membranes oxygenation (ECMO) support, requiring blood transfusion for correction of volume depletion and coagulopathy. The goal of this study is to investigate the long-term outcomes for adults under support of ECMO with massive blood transfusion (MBT).DesignRetrospective nationwide cohort study.SettingData were provided from Taiwan National Health Insurance Research Database (NHIRD).Participants and interventionsTotally 2757 adult patients were identified to receive MBT (red blood cell ≥10 units) during ECMO support from 2000 to 2013 via Taiwan NHIRD.Main outcome measuresThe outcomes included in-hospital major complications/mortality, all-cause mortality, cardiovascular death, newly onset end-stage renal disease and respiratory failure during the follow-up period.ResultsPatients with MBT had higher in-hospital mortality (65.6% vs 52.1%; OR 1.74; 95% CI 1.53 to 1.98) and all-cause mortality during the follow-up (47.0% vs 35.8%; HR 1.46; 95% CI 1.25 to 1.71) than those without MBT. Not only higher incidences of post ECMO sepsis, respiratory failure and acute kidney injury, but also longer duration of ECMO support, ventilator use and intensive care unit stay were demonstrated in the MBT group. Moreover, a subdistribution hazard model presented higher cumulative of respiratory failure (19.8% vs 16.2%; subdistribution HR 1.36; 95% CI 1.07 to 1.73) for the MBT cohort. Positive dose–dependent relationship was found between the amount of transfused red blood cell product and in-hospital mortality. In the MBT subgroup analysis for the impact of transfused ratio (fresh frozen plasma/packed red blood cell) on in-hospital mortality, ratio ≥1.0 had higher mortality.ConclusionsPatients with MBT during ECMO support had worse long-term outcomes than non-MBT population. The transfused amount of red blood cell had positive dose–dependent effect on in-hospital mortality.

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Propensity Score Matched Analysis of Mechanical vs. Bioprosthetic Valve Replacement in Patients With Previous Stroke

Cited by 8 publications

References 23 publications

Sex-related differences on the risks of in-hospital and late outcomes after acute aortic dissection: A nationwide population-based cohort study

Sex-related differences on the risks of in-hospital and late outcomes after acute aortic dissection: A nationwide population-based cohort study

Sex differences in risks of in-hospital and late outcomes after cardiac surgery: a nationwide population-based cohort study

Impact of massive blood transfusion during adult extracorporeal membrane oxygenation support on long-term outcomes: a nationwide cohort study in Taiwan

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