Edward L Hannan1, Zaza Samadashvili2, Nicholas J Stamato3, Stephen J Lahey4, Andrew Wechsler5, Desmond Jordan6, Thoralf M Sundt7, Jeffrey P Gold8, Carlos E Ruiz9, Mohammed H Ashraf10, Craig R Smith6. 1. School of Public Health, University at Albany, State University of New York, Albany, New York. Electronic address: elh03@health.state.ny.us. 2. School of Public Health, University at Albany, State University of New York, Albany, New York. 3. Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming. 4. Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut. 5. Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania. 6. Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York. 7. Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts. 8. University of Nebraska Medical Center, Omaha, Nebraska. 9. Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, New York. 10. Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York.
Abstract
OBJECTIVES: The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. BACKGROUND: TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. METHODS: New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. RESULTS: The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). CONCLUSIONS: TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients.
OBJECTIVES: The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. BACKGROUND: TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. METHODS: New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. RESULTS: The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). CONCLUSIONS: TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients.
Authors: Peter Cram; Saket Girotra; John Matelski; Maria Koh; Bruce E Landon; Lu Han; Douglas S Lee; Dennis T Ko Journal: Circ Cardiovasc Qual Outcomes Date: 2020-01-20
Authors: Declan Lloyd; Jessica G Y Luc; Ben Elias Indja; Vannessa Leung; Nelson Wang; Kevin Phan Journal: J Thorac Dis Date: 2019-01 Impact factor: 2.895