TCT-879 SIMPLIPHieDE (Single center IMPella LVAD supported Pci in High Risk group of patients – Detroit Medical Center Experience) Balloon Aortic Valvuloplasty – Technique and Clinical Outcomes

Abstract

Conclusions:In this series of patients undergoing TAVR and having sequential BNP measurements, baseline BNP did not predict survival, but BNP decreasing by more than 2000 pg/ml 30 days after TAVR was a strong predictor of survival.Background: To serve as comparative data for percutaneous replacement, the purpose of this study was to characterize the historical outcomes for aortic and mitral valve replacement surgery in a large, nationally representative patient population. Methods: Patients undergoing aortic or mitral valve replacement were identified from the 5% national Medicare data (1997-2009) using ICD-9-CM codes 35.21 to 35.24. The subsequent rates of mortality, mechanical complications, infection, and valve reimplantation/reoperation, and infective endocarditis were evaluated. Hospitalization charges and reimbursements (in Jan 2011 dollars) for the index procedure were also assessed. Results: The patient cohort included 12,202 aortic bioprosthesis, 9,757 aortic mechanical valves, 3,222 mitral bioprosthesis, and 4,401 mitral mechanical valves. The ten-year Kaplan-Meier mortality, mechanical complication, infection, re-implantation/reoperation, and infective endocarditis rates for aortic bioprosthesis were 64.4%, 4.41%, 4.54%, 1.50%, and 8.34%, respectively, and for aortic mechanical valves were 63.9%, 5.23%, 4.71%, 1.84%, and 9.08%, respectively. The corresponding ten-year Kaplan-Meier rates for mitral bioprosthesis were 74.8%, 8.02%, 6.29%, 2.81%, and 12.90%, respectively, and for mitral mechanical valves were 64.7%, 7.60%, 6.06%, 2.87%, and 12.24%, respectively. The average hospitalization reimbursements for procedures involving aortic bioprostheses, aortic mechanical valves, mitral bioprostheses, and mitral mechanical valves were $54.3k, $54.6k, $64.1k, and $62.2k, respectively. Conclusions: The crude risk of mortality and complications, as well as payer costs, were found to be higher for mitral valve replacements compared with aortic valve replacements. This study provides baseline data for evaluating the comparative effectiveness of percutaneous valve replacement to "traditional" approaches, especially since the percutaneous approach may have inherently different levels of performance or expanded indications.