Predicting Early and Late Mortality After Transcatheter Aortic Valve Replacement

Hermiller, James; Yakubov, Steven J.; Reardon, Michael J.; Deeb, G. Michael; Adams, David H.; Afilalo, Jonathan; Huang, Jian; Popma, Jeffrey J.

doi:10.1016/j.jacc.2016.04.057

Cited by 146 publications

(97 citation statements)

References 20 publications

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“…Given that there were over 9,600 valve procedures in our dataset, it is likely that the TAVR procedures represent an extremely small component of these. We do recognize that the TAVR patients may have different mortality rates, though the current literature is conflicting (13, 14). Still, the volume of TAVR procedures in the years of study were likely small enough to not have significantly skewed our calculated mortality rates.…”

Section: Discussionmentioning

confidence: 97%

Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania*

Lane‐Fall¹,

Ramaswamy

Brown

et al. 2017

Critical Care Medicine

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Objective Cardiac surgery intensive care unit (ICU) characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. Design From 2012–2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days. Setting Cardiac surgery ICUs in Pennsylvania. Patients Patients having coronary artery bypass grafting (CABG) and/or cardiac valve repair or replacement from 2009 to 2011. Interventions None Measurements and Main Results Out of 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26/43 (60.5%) and pharmacists in 23/43 (53.5%). 26.8% (11/41) reported that at least 2/3 of their nurses had a BSN degree. Advanced practice providers were present in most of the ICUs (37/43, 86.0%), but residents (8/42, 18.6%) and fellows (7/43, 16.3%) were not. Daytime intensivists were present in 48.8% (21/43) of responding ICUs; 18.6% (8/43) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only CABG, and results were similar. Conclusions Pennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

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Section: Discussionmentioning

confidence: 97%

Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania*

Lane‐Fall¹,

Ramaswamy

Brown

et al. 2017

Critical Care Medicine

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“…Currently, TAVR is a treatment modality for patients with severe aortic stenosis, especially those who are at prohibitive or high surgical risk . A number of comorbid conditions have been associated with increased morbidity and mortality after TAVR . However, there are contradicting data on the impact of DM on post‐TAVR outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 A number of comorbid conditions have been associated with increased morbidity and mortality after TAVR. [18][19][20][21] However, there are contradicting data on the impact of DM on post-TAVR outcomes.…”

Section: Major Vascular Complicationsmentioning

confidence: 99%

Diabetes mellitus is associated with increased acute kidney injury and 1‐year mortality after transcatheter aortic valve replacement: A meta‐analysis

Mina

Gill

Soliman

et al. 2017

Clinical Cardiology

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Background Diabetes mellitus (DM) is associated with adverse outcomes after surgical aortic valve replacement. However, there are conflicting data on the impact of DM on outcomes of transcatheter aortic valve replacement (TAVR). Hypothesis DM is associated with poor outcomes after different cardiac procedures. Therefore, DM can also be associated with poor outcomes after TAVR. Methods We searched PubMed and Cochrane Central Register of Controlled Trials for studies that evaluated outcomes after TAVR and stratified at least 1 of the studied endpoints by DM status. The primary endpoint was all‐cause mortality at 1 year. Secondary endpoints were early (up to 30 days) mortality, acute kidney injury (AKI), cerebrovascular accident (CVA), major bleeding, and major vascular complications. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects models. Results We included 64 studies with a total of 38 686 patients. DM was associated with significantly higher 1‐year mortality (OR: 1.14, 95% CI: 1.04‐1.26, P = 0.008) and periprocedural AKI (OR: 1.28, 95% CI: 1.08‐1.52, P = 0.004). On the other hand, there were no significant differences between diabetics and nondiabetics in early mortality, CVAs, major bleeding, or major vascular complications. Conclusions DM is associated with increased 1‐year mortality and periprocedural AKI in patients undergoing TAVR. The results of this study suggest that DM is a predictor of adverse outcomes in patients undergoing TAVR.

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“…Conventional risk scores (such as STS and EuroScore) exclude factors such as liver disease, use of home oxygen, frailty, Charlson comorbidity score and functional disabilities that may render patients high risk for SAVR. These variables are strong predictors death at 30‐days and 1‐year . A simple scoring system created from these predictors effectively stratified patients into low‐, moderate‐, and high‐risk subsets, with a 3‐fold difference in mortality rates between low‐risk and high‐risk patients.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement: The year in review 2016

Harjai

Grines

Paradis

et al. 2017

J Interven Cardiology

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Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations. Meanwhile, there is continued expansion of TAVR to challenging clinical subsets (bicuspid aortic valve [BAV], patients with concomitant advanced coronary artery disease [CAD], and failed surgical bioprostheses), and encouraging initial experiences with newer transcatheter heart valve systems. This paper summarizes the major research studies published on TAVR in 2016.

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Predicting Early and Late Mortality After Transcatheter Aortic Valve Replacement

Cited by 146 publications

References 20 publications

Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania*

Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania*

Diabetes mellitus is associated with increased acute kidney injury and 1‐year mortality after transcatheter aortic valve replacement: A meta‐analysis

Transcatheter aortic valve replacement: The year in review 2016

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