Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency
To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI). The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery beca...
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| creator | Alharbi, Anas A. Khan, Muhammad Z. Osman, Mohammed Khan, Muhammad U. Munir, Muhammad B. Syed, Moinuddin Khan, Safi U. Balla, Sudarshan |
| description | To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI).
The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.
We analyzed the National Inpatient Sample database from January 1, 2016, to December 31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR. Patients with concomitant aortic stenosis, or history of infective endocarditis, and those below the age of 18 years were excluded.
A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P |
| doi_str_mv | 10.1016/j.mayocp.2020.07.030 |
| format | Article |
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The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.
We analyzed the National Inpatient Sample database from January 1, 2016, to December 31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR. Patients with concomitant aortic stenosis, or history of infective endocarditis, and those below the age of 18 years were excluded.
A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P <.001). There was no evidence of a difference in in-hospital mortality between the 2 groups. However, after adjustment, patients in the TAVR group were associated with favorable outcomes in terms of acute kidney injury, cardiogenic shock, postoperative respiratory complications, and length of stay. On the other hand, those in the SAVR group were less likely to need permanent pacemakers.
There was no evidence of a significant statistical difference in in-hospital mortality between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched cohorts. TAVR could be considered for patients with PAI who are not candidates for surgery.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2020.07.030</identifier><identifier>PMID: 33276838</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject><![CDATA[Age ; Age Factors ; Aged ; Aortic stenosis ; Aortic valve ; Aortic valve insufficiency ; Aortic Valve Insufficiency - epidemiology ; Aortic Valve Insufficiency - surgery ; Cardiovascular disease ; Care and treatment ; Comparative analysis ; Data analysis ; Endocarditis ; FDA approval ; Female ; Forecasts and trends ; General & Internal Medicine ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - methods ; Heart valve replacement ; Hospital Costs - statistics & numerical data ; Hospital Mortality ; Hospitals ; Humans ; Kidneys ; Length of Stay - statistics & numerical data ; Life Sciences & Biomedicine ; Male ; Medicine, General & Internal ; Middle Aged ; Mortality ; Outcome and Process Assessment, Health Care ; Pacemakers ; Patients ; Postoperative Complications - classification ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Risk Assessment ; Science & Technology ; Statistical analysis ; Stenosis ; Surgery ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - methods ; Type 2 diabetes ; United States ; United States - epidemiology]]></subject><ispartof>Mayo Clinic proceedings, 2020-12, Vol.95 (12), p.2655-2664</ispartof><rights>2020 Mayo Foundation for Medical Education and Research</rights><rights>Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.</rights><rights>COPYRIGHT 2020 Elsevier, Inc.</rights><rights>COPYRIGHT 2020 Frontline Medical Communications Inc.</rights><rights>Copyright Mayo Foundation for Medical Education and Research Dec 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>18</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000596366300017</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c592t-df63526e9d6b1e647eea4cb52fdefdbec977e52c99846f7dfefa64f382da969c3</citedby><cites>FETCH-LOGICAL-c592t-df63526e9d6b1e647eea4cb52fdefdbec977e52c99846f7dfefa64f382da969c3</cites><orcidid>0000-0003-4724-1912 ; 0000-0002-9804-898X ; 0000-0001-8473-8069 ; 0000-0002-7872-3757</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2467352433?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,315,782,786,887,27931,27932,28255,64392,64394,64396,72476</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33276838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alharbi, Anas A.</creatorcontrib><creatorcontrib>Khan, Muhammad Z.</creatorcontrib><creatorcontrib>Osman, Mohammed</creatorcontrib><creatorcontrib>Khan, Muhammad U.</creatorcontrib><creatorcontrib>Munir, Muhammad B.</creatorcontrib><creatorcontrib>Syed, Moinuddin</creatorcontrib><creatorcontrib>Khan, Safi U.</creatorcontrib><creatorcontrib>Balla, Sudarshan</creatorcontrib><title>Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency</title><title>Mayo Clinic proceedings</title><addtitle>MAYO CLIN PROC</addtitle><addtitle>Mayo Clin Proc</addtitle><description>To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI).
The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.
We analyzed the National Inpatient Sample database from January 1, 2016, to December 31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR. Patients with concomitant aortic stenosis, or history of infective endocarditis, and those below the age of 18 years were excluded.
A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P <.001). There was no evidence of a difference in in-hospital mortality between the 2 groups. However, after adjustment, patients in the TAVR group were associated with favorable outcomes in terms of acute kidney injury, cardiogenic shock, postoperative respiratory complications, and length of stay. On the other hand, those in the SAVR group were less likely to need permanent pacemakers.
There was no evidence of a significant statistical difference in in-hospital mortality between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched cohorts. TAVR could be considered for patients with PAI who are not candidates for surgery.</description><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Aortic valve insufficiency</subject><subject>Aortic Valve Insufficiency - epidemiology</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Comparative analysis</subject><subject>Data analysis</subject><subject>Endocarditis</subject><subject>FDA approval</subject><subject>Female</subject><subject>Forecasts and trends</subject><subject>General & Internal Medicine</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Heart valve replacement</subject><subject>Hospital Costs - statistics & numerical data</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Kidneys</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Medicine, General & Internal</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Outcome and Process Assessment, Health Care</subject><subject>Pacemakers</subject><subject>Patients</subject><subject>Postoperative Complications - classification</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Risk Assessment</subject><subject>Science & Technology</subject><subject>Statistical analysis</subject><subject>Stenosis</subject><subject>Surgery</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><subject>Type 2 diabetes</subject><subject>United States</subject><subject>United States - epidemiology</subject><issn>0025-6196</issn><issn>1942-5546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkl-LEzEUxQdR3Lr6DUQGBBFkxkySyUxehFL8s7Dgoqs-hjRz06bMJN0kU-23N912qxUUyUPCze-c5CYny55WqKxQxV6vykFunVqXGGFUoqZEBN3LJhWnuKhryu5nE4RwXbCKs7PsUQgrhFDDOX2YnRGCG9aSdpKZay9tUDIuIYLPp85Ho_Kvst9A_gnWvVQwgI35JuSfR78wSvYndWPzKxlNWob8m4nL_Gr0cGdzYcOotVFpW20fZw-07AM8Oczn2Zd3b69nH4rLj-8vZtPLQtUcx6LTjNSYAe_YvAJGGwBJ1bzGugPdzUHxpoEaK85bynTTadCSUU1a3EnOuCLn2Zu973qcD9CpdDUve7H2ZpB-K5w04nTHmqVYuI1oKaJVjZLBy4OBdzcjhCgGExT0vbTgxiAwZQ3DqEU79Pkf6MqN3qb2bqnUCCUkUeWeWsgehLHapXNVGh0MRjkL2qT6lNFkWdWYJ8GLE0FiIvyICzmGIP4OLkH2cRlcP0bjbDgF6R5U3oXgQR_fo0JiFyexEvs4iV2cBGpEilOSPfv9LY-iu_wk4NUe-A5zp8PtT8MRS4GrOSOMkbSqmkS3_0_PTJS7PmZutPHXr0KKzsaAFwd5ZzyoKDpn_t3KT86H_zg</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Alharbi, Anas A.</creator><creator>Khan, Muhammad Z.</creator><creator>Osman, Mohammed</creator><creator>Khan, Muhammad U.</creator><creator>Munir, Muhammad B.</creator><creator>Syed, Moinuddin</creator><creator>Khan, Safi U.</creator><creator>Balla, Sudarshan</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier, Inc</general><general>Frontline Medical Communications Inc</general><general>Elsevier Limited</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4U-</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4724-1912</orcidid><orcidid>https://orcid.org/0000-0002-9804-898X</orcidid><orcidid>https://orcid.org/0000-0001-8473-8069</orcidid><orcidid>https://orcid.org/0000-0002-7872-3757</orcidid></search><sort><creationdate>202012</creationdate><title>Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency</title><author>Alharbi, Anas A. ; Khan, Muhammad Z. ; Osman, Mohammed ; Khan, Muhammad U. ; Munir, Muhammad B. ; Syed, Moinuddin ; Khan, Safi U. ; Balla, Sudarshan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c592t-df63526e9d6b1e647eea4cb52fdefdbec977e52c99846f7dfefa64f382da969c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aortic stenosis</topic><topic>Aortic valve</topic><topic>Aortic valve insufficiency</topic><topic>Aortic Valve Insufficiency - epidemiology</topic><topic>Aortic Valve Insufficiency - surgery</topic><topic>Cardiovascular disease</topic><topic>Care and treatment</topic><topic>Comparative analysis</topic><topic>Data analysis</topic><topic>Endocarditis</topic><topic>FDA approval</topic><topic>Female</topic><topic>Forecasts and trends</topic><topic>General & Internal Medicine</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Heart valve replacement</topic><topic>Hospital Costs - statistics & numerical data</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Kidneys</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Medicine, General & Internal</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Outcome and Process Assessment, Health Care</topic><topic>Pacemakers</topic><topic>Patients</topic><topic>Postoperative Complications - classification</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Risk Assessment</topic><topic>Science & Technology</topic><topic>Statistical analysis</topic><topic>Stenosis</topic><topic>Surgery</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Type 2 diabetes</topic><topic>United States</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alharbi, Anas A.</creatorcontrib><creatorcontrib>Khan, Muhammad Z.</creatorcontrib><creatorcontrib>Osman, Mohammed</creatorcontrib><creatorcontrib>Khan, Muhammad U.</creatorcontrib><creatorcontrib>Munir, Muhammad B.</creatorcontrib><creatorcontrib>Syed, Moinuddin</creatorcontrib><creatorcontrib>Khan, Safi U.</creatorcontrib><creatorcontrib>Balla, Sudarshan</creatorcontrib><collection>Web of Science - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alharbi, Anas A.</au><au>Khan, Muhammad Z.</au><au>Osman, Mohammed</au><au>Khan, Muhammad U.</au><au>Munir, Muhammad B.</au><au>Syed, Moinuddin</au><au>Khan, Safi U.</au><au>Balla, Sudarshan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency</atitle><jtitle>Mayo Clinic proceedings</jtitle><stitle>MAYO CLIN PROC</stitle><addtitle>Mayo Clin Proc</addtitle><date>2020-12</date><risdate>2020</risdate><volume>95</volume><issue>12</issue><spage>2655</spage><epage>2664</epage><pages>2655-2664</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><abstract>To compare the outcomes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with pure aortic insufficiency (PAI).
The treatment of choice for patients with severe symptomatic PAI is SAVR. However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.
We analyzed the National Inpatient Sample database from January 1, 2016, to December 31, 2017, using the International Classification of Diseases, 10th Revision. Inclusion criteria were patients with aortic valve insufficiency undergoing either TAVR or SAVR. Patients with concomitant aortic stenosis, or history of infective endocarditis, and those below the age of 18 years were excluded.
A total of 14,720 patients with PAI underwent valve replacement. Of those, 6.2% underwent TAVR. The TAVR group was significantly older (median age 78 years vs 64 years; P <.001). There was no evidence of a difference in in-hospital mortality between the 2 groups. However, after adjustment, patients in the TAVR group were associated with favorable outcomes in terms of acute kidney injury, cardiogenic shock, postoperative respiratory complications, and length of stay. On the other hand, those in the SAVR group were less likely to need permanent pacemakers.
There was no evidence of a significant statistical difference in in-hospital mortality between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched cohorts. TAVR could be considered for patients with PAI who are not candidates for surgery.</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>33276838</pmid><doi>10.1016/j.mayocp.2020.07.030</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4724-1912</orcidid><orcidid>https://orcid.org/0000-0002-9804-898X</orcidid><orcidid>https://orcid.org/0000-0001-8473-8069</orcidid><orcidid>https://orcid.org/0000-0002-7872-3757</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Age Factors Aged Aortic stenosis Aortic valve Aortic valve insufficiency Aortic Valve Insufficiency - epidemiology Aortic Valve Insufficiency - surgery Cardiovascular disease Care and treatment Comparative analysis Data analysis Endocarditis FDA approval Female Forecasts and trends General & Internal Medicine Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - methods Heart valve replacement Hospital Costs - statistics & numerical data Hospital Mortality Hospitals Humans Kidneys Length of Stay - statistics & numerical data Life Sciences & Biomedicine Male Medicine, General & Internal Middle Aged Mortality Outcome and Process Assessment, Health Care Pacemakers Patients Postoperative Complications - classification Postoperative Complications - etiology Postoperative Complications - mortality Risk Assessment Science & Technology Statistical analysis Stenosis Surgery Transcatheter Aortic Valve Replacement - adverse effects Transcatheter Aortic Valve Replacement - methods Type 2 diabetes United States United States - epidemiology |
| title | Transcatheter Aortic Valve Replacement vs Surgical Replacement in Patients With Pure Aortic Insufficiency |
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