Evolving trends in aortic valve replacement: A statewide experience

Kim, Karen M.; Shannon, Francis; Paone, Gaetano; Lall, Shelly C.; Batra, Sanjay; Boeve, Theodore; DeLucia, Alphonse; Patel, Himanshu J.; Theurer, Patricia F.; He, Chang; Clark, Melissa J.; Sultan, Ibrahim; Deeb, G. Michael; Prager, Richard L.

doi:10.1111/jocs.13740

Cited by 50 publications

(30 citation statements)

References 15 publications

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“…In comparison to earlier studies that demonstrated steady increase in SAVR volume after TAVR program initiation, our study identified an inflection point after the initial volume increase followed by decline in the volume back to approximately the baseline level. Similar observation has been made at a state‐level data in Michigan . Concurrently observed was a significant increase in TAVR volume performed on patients with nonhigh risk populations.…”

Section: Discussionsupporting

confidence: 82%

“…European experience that preceded the FDA approval in the U.S. provided initial insight into the ‘halo’ effect, in which 37% increase in SAVR volume was observed in a center that initiated TAVR programs, assumed to be due to increase in the overall referral volume via the multidisciplinary heart valve program. Subsequently, a similar phenomenon was observed in U.S. studies at an institutional, state‐wide, and national levels . This increase has been surmised to be due to the increase in overall AVR referral volume owing to the institution of TAVR programs.…”

Section: Discussionsupporting

confidence: 62%

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Trends in volume and risk profiles of patients undergoing isolated surgical and transcatheter aortic valve replacement

Mori

Mahmood

Geirsson

et al. 2018

Cathet Cardio Intervent

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Background Recent reports describe increases in the case volume of surgical aortic valve replacement (SAVR) after centers establish a transcatheter aortic valve replacement (TAVR) program. We investigate contemporary temporal trends in SAVR and TAVR case volumes and risk profiles at a high volume academic medical center. Methods We conducted a retrospective, descriptive evaluation of consecutive patients who underwent TAVR (n = 538) or SAVR (n = 657) in 2011–2016. The STS predicted risk of mortality (PROM) for isolated SAVR was used to calculate PROM for both SAVR and TAVR patients. Patients were stratified based on STS PROM as follows: low risk (<4%), intermediate risk (4–8%), and high risk (≥8%). Temporal changes in patient risk‐profile were characterized descriptively. Results Median STS PROM for the study period was 6.3% and 2.0% for TAVR and SAVR cohorts, respectively (P < 0.001). Since 2011, TAVR volume consistently increased, while SAVR volume increased initially, peaking in 2013 and steadily declined. The STS PROM for SAVR remained stable during the entire study period, while that for TAVR showed a steady decline. The proportions of intermediate and low STS PROM patients undergoing TAVR increased. Proportions of each risk category in SAVR cohort remained stable over time. Conclusions SAVR volume increased initially but declined eventually following the implementation of TAVR program. The distribution of the STS PROM in TAVR cohort changed dramatically with increasing proportion of patients in lower risk categories. These findings suggest the converging patient populations in TAVR and SAVR, which may be associated with the decline in the overall SAVR volume.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 62%

Trends in volume and risk profiles of patients undergoing isolated surgical and transcatheter aortic valve replacement

Mori

Mahmood

Geirsson

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…However, between 50 and 70 years of age, patient preference is the dominant factor affecting the choice of a prosthesis. With rapid growth of transcatheter AVR (TAVR) over the past decade, the use of bAVR has had simultaneous increase in growth, with the thought that a valve‐in‐valve (V‐I‐V) TAVR could be performed when structural valve degeneration (SVD) of the bAVR occurs …”

Section: Introductionmentioning

confidence: 99%

Hospital readmission rates are similar between patients with mechanical versus bioprosthetic aortic valves

et al. 2018

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“…In this edition of the Journal, Kim et al report the most recent trends in surgical (SAVR) and transcatheter (TAVR) aortic valve replacement from the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative database from 2012 to 2017. They found that the total annual AVR volume increased by 40% (2086‐2920) with a 13.3% decrease in SAVR (1892‐1640) and a 560% increase in TAVR (194‐1280).…”

mentioning

confidence: 99%

TAVR versus SAVR: Who determines the risk?

Lazar

2018

J Card Surg

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Evolving trends in aortic valve replacement: A statewide experience

Abstract: During the study period, SAVR volume gradually declined and TAVR volume dramatically increased. This was mostly due to a new group of patients with lower STS PROM who were designated as higher risk by a Heart Team due to characteristics not completely captured by the STS PROM score.

Cited by 50 publications

References 15 publications

Trends in volume and risk profiles of patients undergoing isolated surgical and transcatheter aortic valve replacement

Trends in volume and risk profiles of patients undergoing isolated surgical and transcatheter aortic valve replacement

Hospital readmission rates are similar between patients with mechanical versus bioprosthetic aortic valves

TAVR versus SAVR: Who determines the risk?

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