Divyanshu Mohananey1, Pedro Villablanca2, Tanush Gupta3, Sagar Ranka4, Nirmanmoh Bhatia5, Oluwole Adegbala6, Tomo Ando7, Dee Dee Wang2, Jose M Wiley3, Marvin Eng2, Ankur Kalra8, Harish Ramakrishna9, Binita Shah10, William O'Neill2, Jorge Saucedo1, Deepak L Bhatt11. 1. Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 2. Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan. 3. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 4. Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois. 5. Division of Cardiovascular Medicine, Vanderbilt, University Medical Center, Nashville, Tennessee. 6. Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, South Orange, New Jersey. 7. Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan. 8. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 9. Department of Anesthesiology, Mayo Clinic, Scottsdale, Arizona. 10. Leon H. Charney Division of Cardiology, New York University, New York, New York. 11. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVES: The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in-hospital outcomes after endovascular transcatheter aortic valve replacement (EV-TAVR). BACKGROUND: TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV-TAVR are limited. METHODS: Patients in the National Inpatient Sample who underwent EV-TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in-hospital mortality. RESULTS: A total of 51,685 patients underwent EV-TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in-hospital mortality [OR 1.08 (95% CI 0.83-1.41)], permanent pacemaker implantation [OR 0.98 (0.85-1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49-2.26)], or acute myocardial infarction [OR 1.31(0.99-1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50-2.16)], major bleeding [OR 1.20 (1.09-1.34)], acute kidney injury (AKI) [OR 1.19 (1.05-1.36)], cardiac complications [aOR 1.21 (1.01-1.44)], and stroke [OR 1.39(1.10-1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. CONCLUSION: Of patients undergoing EV-TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in-hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.
OBJECTIVES: The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in-hospital outcomes after endovascular transcatheter aortic valve replacement (EV-TAVR). BACKGROUND: TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV-TAVR are limited. METHODS:Patients in the National Inpatient Sample who underwent EV-TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in-hospital mortality. RESULTS: A total of 51,685 patients underwent EV-TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in-hospital mortality [OR 1.08 (95% CI 0.83-1.41)], permanent pacemaker implantation [OR 0.98 (0.85-1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49-2.26)], or acute myocardial infarction [OR 1.31(0.99-1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50-2.16)], major bleeding [OR 1.20 (1.09-1.34)], acute kidney injury (AKI) [OR 1.19 (1.05-1.36)], cardiac complications [aOR 1.21 (1.01-1.44)], and stroke [OR 1.39(1.10-1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. CONCLUSION: Of patients undergoing EV-TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in-hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.
Authors: Martin B Leon; Craig R Smith; Michael Mack; D Craig Miller; Jeffrey W Moses; Lars G Svensson; E Murat Tuzcu; John G Webb; Gregory P Fontana; Raj R Makkar; David L Brown; Peter C Block; Robert A Guyton; Augusto D Pichard; Joseph E Bavaria; Howard C Herrmann; Pamela S Douglas; John L Petersen; Jodi J Akin; William N Anderson; Duolao Wang; Stuart Pocock Journal: N Engl J Med Date: 2010-09-22 Impact factor: 91.245
Authors: Divyanshu Mohananey; Brian P Griffin; Lars G Svensson; Zoran B Popovic; E Murat Tuzcu; L Leonardo Rodriguez; Samir R Kapadia; Milind Y Desai Journal: Circ Cardiovasc Interv Date: 2017-10 Impact factor: 6.546
Authors: Hans Gustav Hørsted Thyregod; Daniel Andreas Steinbrüchel; Nikolaj Ihlemann; Henrik Nissen; Bo Juel Kjeldsen; Petur Petursson; Yanping Chang; Olaf Walter Franzen; Thomas Engstrøm; Peter Clemmensen; Peter Bo Hansen; Lars Willy Andersen; Peter Skov Olsen; Lars Søndergaard Journal: J Am Coll Cardiol Date: 2015-03-15 Impact factor: 24.094
Authors: Raffaele Piccolo; Thomas Pilgrim; Anna Franzone; Marco Valgimigli; Alan Haynes; Masahiko Asami; Jonas Lanz; Lorenz Räber; Fabien Praz; Bettina Langhammer; Eva Roost; Stephan Windecker; Stefan Stortecky Journal: JACC Cardiovasc Interv Date: 2017-07-24 Impact factor: 11.195
Authors: Mark R Nehler; Sue Duval; Lihong Diao; Brian H Annex; William R Hiatt; Kevin Rogers; Armen Zakharyan; Alan T Hirsch Journal: J Vasc Surg Date: 2014-05-10 Impact factor: 4.268
Authors: Tanush Gupta; Sahil Khera; Dhaval Kolte; Kashish Goel; Ankur Kalra; Pedro A Villablanca; Herbert D Aronow; J Dawn Abbott; Gregg C Fonarow; Cynthia C Taub; Neal S Kleiman; Giora Weisz; Ignacio Inglessis; Sammy Elmariah; Charanjit S Rihal; Mario J Garcia; Deepak L Bhatt Journal: Circ Cardiovasc Interv Date: 2018-04 Impact factor: 6.546
Authors: Rajiv Tayal; Michael DiVita; Christoph W Sossou; Alexis K Okoh; Kelly Stelling; James M McCabe; Amir Kaki; Najam Wasty; David A Baran Journal: J Interv Cardiol Date: 2020-07-26 Impact factor: 2.279