A shifting approach to management of the thoracic aorta in bicuspid aortic valve
Objectives The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among...
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| creator | Opotowsky, Alexander R., MD, MPH Perlstein, Todd, MD Landzberg, Michael J., MD Colan, Steven D., MD O’Gara, Patrick T., MD Body, Simon C., MBChB, MPH Ryan, Liam F., MD Aranki, Sary, MD Singh, Michael N., MD |
| description | Objectives The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States. Methods We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery. Results Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 ( P |
| doi_str_mv | 10.1016/j.jtcvs.2012.10.028 |
| format | Article |
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We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States. Methods We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery. Results Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 ( P < .0001). The proportion of aortic valve repair or replacement including concomitant thoracic aortic surgery increased from 12.8% ± 1.4% in 1998/1999 to 28.5% ± 1.6% in 2008/2009, which mirrored an increasing proportion of patients with a diagnosis of thoracic aortic aneurysm. Mortality was equivalent for patients undergoing aortic valve repair or replacement with thoracic aortic surgery and those undergoing isolated aortic valve repair or replacement (1.8% ± 0.3% vs 1.5% ± 0.2%; multivariable odds ratio, 1.02; 95% confidence interval, 0.67-1.57), with decreasing mortality over the study period (from 2.5% ± 0.6% in 1998/1999 to 1.5% ± 0.2% in 2008/2009; multivariable odds ratio per 2-year increment, 0.89; 95% confidence interval, 0.81-0.99; P = .03). Total charges for BAV surgical hospitalizations increased more than 7.5-fold from approximately $156 million in 1998 to $1.2 billion in 2009 (inflation-adjusted 2009 dollars). Conclusions There was a marked increase in the use of thoracic aortic surgery among patients with BAV.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2012.10.028</identifier><identifier>PMID: 23142124</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aorta, Thoracic - surgery ; Aortic Aneurysm, Thoracic - economics ; Aortic Aneurysm, Thoracic - etiology ; Aortic Aneurysm, Thoracic - mortality ; Aortic Aneurysm, Thoracic - surgery ; Aortic Valve - abnormalities ; Aortic Valve - surgery ; Bicuspid Aortic Valve Disease ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - economics ; Cardiac Surgical Procedures - mortality ; Cardiac Surgical Procedures - trends ; Cardiothoracic Surgery ; Databases as Topic ; Dilatation, Pathologic ; Female ; Heart Valve Diseases - complications ; Heart Valve Diseases - economics ; Heart Valve Diseases - mortality ; Heart Valve Diseases - surgery ; Heart Valve Prosthesis Implantation - trends ; Hospital Costs - trends ; Humans ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Practice Patterns, Physicians' - economics ; Practice Patterns, Physicians' - trends ; Risk Factors ; Time Factors ; Treatment Outcome ; United States ; Vascular Surgical Procedures - adverse effects ; Vascular Surgical Procedures - economics ; Vascular Surgical Procedures - mortality ; Vascular Surgical Procedures - trends ; Young Adult</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2013-08, Vol.146 (2), p.339-346</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2013 The American Association for Thoracic Surgery</rights><rights>Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><rights>Copyright © 2013 by The American Association for Thoracic Surgery 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c613t-5f250696b4716ee5cecb30b6bd0da22ba2060e74df09856057898da5df34333c3</citedby><cites>FETCH-LOGICAL-c613t-5f250696b4716ee5cecb30b6bd0da22ba2060e74df09856057898da5df34333c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522312013335$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23142124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Opotowsky, Alexander R., MD, MPH</creatorcontrib><creatorcontrib>Perlstein, Todd, MD</creatorcontrib><creatorcontrib>Landzberg, Michael J., MD</creatorcontrib><creatorcontrib>Colan, Steven D., MD</creatorcontrib><creatorcontrib>O’Gara, Patrick T., MD</creatorcontrib><creatorcontrib>Body, Simon C., MBChB, MPH</creatorcontrib><creatorcontrib>Ryan, Liam F., MD</creatorcontrib><creatorcontrib>Aranki, Sary, MD</creatorcontrib><creatorcontrib>Singh, Michael N., MD</creatorcontrib><title>A shifting approach to management of the thoracic aorta in bicuspid aortic valve</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objectives The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States. Methods We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery. Results Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 ( P < .0001). The proportion of aortic valve repair or replacement including concomitant thoracic aortic surgery increased from 12.8% ± 1.4% in 1998/1999 to 28.5% ± 1.6% in 2008/2009, which mirrored an increasing proportion of patients with a diagnosis of thoracic aortic aneurysm. Mortality was equivalent for patients undergoing aortic valve repair or replacement with thoracic aortic surgery and those undergoing isolated aortic valve repair or replacement (1.8% ± 0.3% vs 1.5% ± 0.2%; multivariable odds ratio, 1.02; 95% confidence interval, 0.67-1.57), with decreasing mortality over the study period (from 2.5% ± 0.6% in 1998/1999 to 1.5% ± 0.2% in 2008/2009; multivariable odds ratio per 2-year increment, 0.89; 95% confidence interval, 0.81-0.99; P = .03). Total charges for BAV surgical hospitalizations increased more than 7.5-fold from approximately $156 million in 1998 to $1.2 billion in 2009 (inflation-adjusted 2009 dollars). Conclusions There was a marked increase in the use of thoracic aortic surgery among patients with BAV.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Aneurysm, Thoracic - economics</subject><subject>Aortic Aneurysm, Thoracic - etiology</subject><subject>Aortic Aneurysm, Thoracic - mortality</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Aortic Valve - abnormalities</subject><subject>Aortic Valve - surgery</subject><subject>Bicuspid Aortic Valve Disease</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiac Surgical Procedures - economics</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Cardiac Surgical Procedures - trends</subject><subject>Cardiothoracic Surgery</subject><subject>Databases as Topic</subject><subject>Dilatation, Pathologic</subject><subject>Female</subject><subject>Heart Valve Diseases - complications</subject><subject>Heart Valve Diseases - economics</subject><subject>Heart Valve Diseases - mortality</subject><subject>Heart Valve Diseases - surgery</subject><subject>Heart Valve Prosthesis Implantation - trends</subject><subject>Hospital Costs - trends</subject><subject>Humans</subject><subject>Linear Models</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Practice Patterns, Physicians' - economics</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vascular Surgical Procedures - economics</subject><subject>Vascular Surgical Procedures - mortality</subject><subject>Vascular Surgical Procedures - trends</subject><subject>Young Adult</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUl2L1TAQDaK419VfIEgffel1kjRp--DCsqwfsKCggm8hTaf3prZNTdLC_nvTveuivvgQAjPnnBnOGUJeUthToPJNv--jWcOeAWWpsgdWPSI7CnWZy0p8f0x2AIzlgjF-Rp6F0ANACbR-Ss4YpwWjrNiRz5dZONou2umQ6Xn2TptjFl026kkfcMQpZq7L4hHTc14bazLtfNSZnbLGmiXMtr2rpMaqhxWfkyedHgK-uP_Pybd311-vPuQ3n95_vLq8yY2kPOaiYwJkLZuipBJRGDQNh0Y2LbSasUYzkIBl0XZQV0KCKKu6arVoO15wzg0_Jxcn3XlpRmxN2tTrQc3ejtrfKqet-rsz2aM6uFUVUMnkTxJ4fS_g3c8FQ1SjDQaHQU_olqBoQanktGIyQfkJarwLwWP3MIaC2rJQvbrLQm1ZbMWURWK9-nPDB85v8xPg7QmAyafVolfBWJwMttajiap19j8DLv7hm8FO1ujhB95i6N3ipxSBoiowBerLdg7bNdAkkjwU_Be3k7GC</recordid><startdate>20130801</startdate><enddate>20130801</enddate><creator>Opotowsky, Alexander R., MD, MPH</creator><creator>Perlstein, Todd, MD</creator><creator>Landzberg, Michael J., MD</creator><creator>Colan, Steven D., MD</creator><creator>O’Gara, Patrick T., MD</creator><creator>Body, Simon C., MBChB, MPH</creator><creator>Ryan, Liam F., MD</creator><creator>Aranki, Sary, MD</creator><creator>Singh, Michael N., MD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130801</creationdate><title>A shifting approach to management of the thoracic aorta in bicuspid aortic valve</title><author>Opotowsky, Alexander R., MD, MPH ; Perlstein, Todd, MD ; Landzberg, Michael J., MD ; Colan, Steven D., MD ; O’Gara, Patrick T., MD ; Body, Simon C., MBChB, MPH ; Ryan, Liam F., MD ; Aranki, Sary, MD ; Singh, Michael N., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c613t-5f250696b4716ee5cecb30b6bd0da22ba2060e74df09856057898da5df34333c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Aneurysm, Thoracic - economics</topic><topic>Aortic Aneurysm, Thoracic - etiology</topic><topic>Aortic Aneurysm, Thoracic - mortality</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Aortic Valve - abnormalities</topic><topic>Aortic Valve - surgery</topic><topic>Bicuspid Aortic Valve Disease</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Cardiac Surgical Procedures - economics</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Cardiac Surgical Procedures - trends</topic><topic>Cardiothoracic Surgery</topic><topic>Databases as Topic</topic><topic>Dilatation, Pathologic</topic><topic>Female</topic><topic>Heart Valve Diseases - complications</topic><topic>Heart Valve Diseases - economics</topic><topic>Heart Valve Diseases - mortality</topic><topic>Heart Valve Diseases - surgery</topic><topic>Heart Valve Prosthesis Implantation - trends</topic><topic>Hospital Costs - trends</topic><topic>Humans</topic><topic>Linear Models</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Practice Patterns, Physicians' - economics</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - economics</topic><topic>Vascular Surgical Procedures - mortality</topic><topic>Vascular Surgical Procedures - trends</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Opotowsky, Alexander R., MD, MPH</creatorcontrib><creatorcontrib>Perlstein, Todd, MD</creatorcontrib><creatorcontrib>Landzberg, Michael J., MD</creatorcontrib><creatorcontrib>Colan, Steven D., MD</creatorcontrib><creatorcontrib>O’Gara, Patrick T., MD</creatorcontrib><creatorcontrib>Body, Simon C., MBChB, MPH</creatorcontrib><creatorcontrib>Ryan, Liam F., MD</creatorcontrib><creatorcontrib>Aranki, Sary, MD</creatorcontrib><creatorcontrib>Singh, Michael N., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Opotowsky, Alexander R., MD, MPH</au><au>Perlstein, Todd, MD</au><au>Landzberg, Michael J., MD</au><au>Colan, Steven D., MD</au><au>O’Gara, Patrick T., MD</au><au>Body, Simon C., MBChB, MPH</au><au>Ryan, Liam F., MD</au><au>Aranki, Sary, MD</au><au>Singh, Michael N., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A shifting approach to management of the thoracic aorta in bicuspid aortic valve</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2013-08-01</date><risdate>2013</risdate><volume>146</volume><issue>2</issue><spage>339</spage><epage>346</epage><pages>339-346</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objectives The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States. Methods We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery. Results Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 ( P < .0001). The proportion of aortic valve repair or replacement including concomitant thoracic aortic surgery increased from 12.8% ± 1.4% in 1998/1999 to 28.5% ± 1.6% in 2008/2009, which mirrored an increasing proportion of patients with a diagnosis of thoracic aortic aneurysm. Mortality was equivalent for patients undergoing aortic valve repair or replacement with thoracic aortic surgery and those undergoing isolated aortic valve repair or replacement (1.8% ± 0.3% vs 1.5% ± 0.2%; multivariable odds ratio, 1.02; 95% confidence interval, 0.67-1.57), with decreasing mortality over the study period (from 2.5% ± 0.6% in 1998/1999 to 1.5% ± 0.2% in 2008/2009; multivariable odds ratio per 2-year increment, 0.89; 95% confidence interval, 0.81-0.99; P = .03). Total charges for BAV surgical hospitalizations increased more than 7.5-fold from approximately $156 million in 1998 to $1.2 billion in 2009 (inflation-adjusted 2009 dollars). Conclusions There was a marked increase in the use of thoracic aortic surgery among patients with BAV.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23142124</pmid><doi>10.1016/j.jtcvs.2012.10.028</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aorta, Thoracic - surgery Aortic Aneurysm, Thoracic - economics Aortic Aneurysm, Thoracic - etiology Aortic Aneurysm, Thoracic - mortality Aortic Aneurysm, Thoracic - surgery Aortic Valve - abnormalities Aortic Valve - surgery Bicuspid Aortic Valve Disease Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - economics Cardiac Surgical Procedures - mortality Cardiac Surgical Procedures - trends Cardiothoracic Surgery Databases as Topic Dilatation, Pathologic Female Heart Valve Diseases - complications Heart Valve Diseases - economics Heart Valve Diseases - mortality Heart Valve Diseases - surgery Heart Valve Prosthesis Implantation - trends Hospital Costs - trends Humans Linear Models Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Practice Patterns, Physicians' - economics Practice Patterns, Physicians' - trends Risk Factors Time Factors Treatment Outcome United States Vascular Surgical Procedures - adverse effects Vascular Surgical Procedures - economics Vascular Surgical Procedures - mortality Vascular Surgical Procedures - trends Young Adult |
| title | A shifting approach to management of the thoracic aorta in bicuspid aortic valve |
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