Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation
Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatien...
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| Veröffentlicht in: | The American journal of cardiology 2020-07, Vol.126, p.73-81 |
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| creator | Akintoye, Emmanuel Ando, Tomo Sandio, Aubin Adegbala, Oluwole Salih, Mohamed Zubairu, Josiah Oseni, Abdullahi Sistla, Phanicharan Alqasrawi, Musab Egbe, Alexander Mentias, Amgad Afonso, Luis Briasoulis, Alexandros Panaich, Sidakpal Desai, Milind Y. |
| description | Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p |
| doi_str_mv | 10.1016/j.amjcard.2020.03.038 |
| format | Article |
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However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (−4.0% vs −6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2020.03.038</identifier><identifier>PMID: 32336533</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Aorta ; Aortic stenosis ; Aortic valve ; Clinical trials ; Comorbidity ; Heart valves ; Hospitals ; Implantation ; Kidneys ; Mortality ; Pacemakers ; Patients ; Stenosis ; Surgical implants ; Thoracic surgery ; Transplants & implants ; Trends</subject><ispartof>The American journal of cardiology, 2020-07, Vol.126, p.73-81</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-8d6d7d9cefde4607c84e7b9119ce47f63b0b1c877b4f99162c2c9ee4492d6f133</citedby><cites>FETCH-LOGICAL-c393t-8d6d7d9cefde4607c84e7b9119ce47f63b0b1c877b4f99162c2c9ee4492d6f133</cites><orcidid>0000-0002-5740-9670 ; 0000-0002-1264-3383 ; 0000-0002-7618-5983</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2425685088?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32336533$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Akintoye, Emmanuel</creatorcontrib><creatorcontrib>Ando, Tomo</creatorcontrib><creatorcontrib>Sandio, Aubin</creatorcontrib><creatorcontrib>Adegbala, Oluwole</creatorcontrib><creatorcontrib>Salih, Mohamed</creatorcontrib><creatorcontrib>Zubairu, Josiah</creatorcontrib><creatorcontrib>Oseni, Abdullahi</creatorcontrib><creatorcontrib>Sistla, Phanicharan</creatorcontrib><creatorcontrib>Alqasrawi, Musab</creatorcontrib><creatorcontrib>Egbe, Alexander</creatorcontrib><creatorcontrib>Mentias, Amgad</creatorcontrib><creatorcontrib>Afonso, Luis</creatorcontrib><creatorcontrib>Briasoulis, Alexandros</creatorcontrib><creatorcontrib>Panaich, Sidakpal</creatorcontrib><creatorcontrib>Desai, Milind Y.</creatorcontrib><title>Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (−4.0% vs −6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.</description><subject>Age</subject><subject>Aorta</subject><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Heart valves</subject><subject>Hospitals</subject><subject>Implantation</subject><subject>Kidneys</subject><subject>Mortality</subject><subject>Pacemakers</subject><subject>Patients</subject><subject>Stenosis</subject><subject>Surgical implants</subject><subject>Thoracic surgery</subject><subject>Transplants & 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Valve Implantation</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>126</volume><spage>73</spage><epage>81</epage><pages>73-81</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (−4.0% vs −6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32336533</pmid><doi>10.1016/j.amjcard.2020.03.038</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5740-9670</orcidid><orcidid>https://orcid.org/0000-0002-1264-3383</orcidid><orcidid>https://orcid.org/0000-0002-7618-5983</orcidid></addata></record> |
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| subjects | Age Aorta Aortic stenosis Aortic valve Clinical trials Comorbidity Heart valves Hospitals Implantation Kidneys Mortality Pacemakers Patients Stenosis Surgical implants Thoracic surgery Transplants & implants Trends |
| title | Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation |
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