Hospital outcomes of transcatheter versus surgical aortic valve replacement in female in the United States

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

doi:10.1002/ccd.27362

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…Short term, in‐patient mortality of TAVR vs. SAVR in female has been discussed previously. Although it was a sub‐group analysis with no adjustments for confounding factors, our results were different from previous studies that showed similar short‐term mortality in females between TAVR and SAVR . The major difference in our study, compared to the previous ones, is that our perioperative outcomes were restricted to non‐teaching hospitals.…”

Section: Discussioncontrasting

confidence: 76%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Ando

Adegbala

Villablanca

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in non‐teaching hospitals. Background TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non‐teaching hospitals are largely under explored. Methods We queried the Nationwide Inpatient Sample database from 2011 to September 2015 to identify those who were 50 years or above and underwent either trans‐arterial TAVR or SAVR at non‐teaching hospital. In‐hospital clinical outcomes were compared with odds ratio (OR) in propensity‐matched cohorts. Results We identified un‐weighted 957 and 7,465 SAVR admissions. In propensity‐matched model, 596 admissions in each arm were included for final analysis. In‐patient mortality (3.9 vs. 2.5%, OR 1.54, P = 0.34), acute kidney injury requiring dialysis (2.2 vs. 2.7%, OR 0.80, P = 0.57), stroke (2.0 vs. 3.2%, OR 0.61, P = 0.20), and pacemaker placement (8.9 vs. 6.4%, OR 1.47, P = 0.09) was similar between TAVR and SAVR. Sub‐group analysis showed that female and those with prior coronary artery bypass surgery had higher risk of in‐patient morality in TAVR admission. Cost was higher (59,103 vs. 53,411 dollars, P = 0.006) but length of stay was shorter in TAVR (6.9 vs. 10.2 days, P < 0.001). Conclusions TAVR conferred similar in‐hospital mortality and major peri‐procedural complications compared with SAVR in non‐teaching hospitals. For those with limited access to teaching hospitals, non‐teaching hospitals appear to be a reasonable option for candidates of aortic valve replacement for severe aortic stenosis.

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Section: Discussioncontrasting

confidence: 76%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

Ando

Adegbala

Villablanca

et al. 2018

Cathet Cardio Intervent

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“…Therefore, we used the outcome of in‐hospital mortality as the primary outcome. Furthermore, the definitions we used for secondary outcomes have been previously described in other studies comparing TAVR versus SAVR using the Healthcare Cost and Utilization Project . Third, the clinical reasoning for undergoing TAVR or SAVR could not be determined.…”

Section: Discussionmentioning

confidence: 99%

“…We also excluded those who underwent concomitant TAVR and SAVR during the same hospitalization (only seven records) since we considered this as a complication of the TAVR. This approach has been used to compare TAVR versus SAVR in previous studies utilizing the NIS for other populations …”

Section: Methodsmentioning

confidence: 99%

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Elgendy

Mahmoud

Elbadawi

et al. 2018

Cathet Cardio Intervent

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Objectives To compare the in‐hospital outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in nonagenarians. Background Data comparing the outcomes of TAVR versus SAVR in nonagenarians are limited. Methods Using the National Inpatient Sample years 2012–2014, hospitalization data were retrieved for subjects aged ≥90 years who underwent TAVR or SAVR for severe aortic stenosis. The incidence of in‐hospital mortality and peri‐procedural outcomes were compared using unadjusted, multivariate logistic regression, and propensity score matched analyses. Results The final cohort included 6,680 records of nonagenarians undergoing aortic valve replacement, among which 5,840 (87.4%) underwent TAVR. There was no difference in the incidence of in‐hospital mortality between both groups in the unadjusted (5.8% versus 6.0% P = 0.95), multivariate (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35–1.74), and propensity score matched (OR 1.07, 95% CI 0.75–1.51) analyses. In the propensity‐matched analysis, TAVR was associated with a lower incidence of acute kidney injury (OR 0.58, 95% CI 0.47–0.72), post‐operative blood transfusion (OR 0.51, 95% CI 0.43–0.61), a higher likelihood of discharge to home (OR 4.71, 95% 3.44–5.06), and a similar incidence of pacemaker placement (OR 1.16, 95% 0.89–1.53) and stroke (OR 1.34, 0.90–1.99). Conclusions In this nationwide analysis, TAVR was associated with an overall similar incidence of in‐hospital mortality and less morbidity compared with SAVR. These findings suggest that TAVR is effective and safe in nonagenarians.

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“…LOS is often influenced by adverse events following surgery, and given that being female is a risk factor for increased adverse events during cardiac surgery, it was important to examine the LOS for female TAVR recipients [ 13 ]. One study looked at female patients who either underwent TAVR or SAVR from 2011 to 2014 in the Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) database (n = 21,661) and found that the LOS for female patients who underwent TAVR was shorter (7.8 days) compared to patients who received SAVR (10.5 days) [ 13 ]. Interestingly, patients who received TAVR during this time period were in general older and had a higher burden of comorbidities than SAVR recipients [ 13 ].…”

Section: Reviewmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR): A Review on the Length of Stay, Cost, Comorbidities, and Procedural Complications

Kermanshahchi,

Thind,

Davoodpour

et al. 2024

Cureus

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This review provides an in-depth analysis of the effect of length of stay (LOS), comorbidities, and procedural complications on the cost-effectiveness of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR). We found that the average LOS was shorter for patients undergoing TAVR, contributing to lower average costs associated with the procedure, although the LOS varied between patients due to the severity of illness and comorbidities present. TAVR has also been found to improve the quality of life for patients receiving aortic valve replacement compared to SAVR. Although TAVR has a lower rate of most post-operative complications caused by SAVR, such as bleeding and cardiac complications, TAVR shows an increased rate of permanent pacemaker (PPM) implantation due to mechanical trauma on the heart’s conduction system. In addition, our findings suggest that the cost-effectiveness of each procedure varies based on the types of valve, the patient history of other medical conditions, and the procedural methods. Our findings show that TAVR is preferred over SAVR in terms of cost-effectiveness across a variety of patients with other coexisting medical conditions, including cancer, advanced kidney disease, cirrhosis, diabetes mellitus, and bundle branch block. TAVR also appears to be superior to SAVR with fewer post-operative complications. However, TAVR appears to have a higher rate of PPM implantation rates as compared to SAVR. The comorbidities of the valve recipient must be considered when deciding whether to use TAVR or SAVR as cost-effectiveness varies with the patient background.

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Hospital outcomes of transcatheter versus surgical aortic valve replacement in female in the United States

Cited by 6 publications

References 20 publications

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals

In‐hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians

Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR): A Review on the Length of Stay, Cost, Comorbidities, and Procedural Complications

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