Ashraf Abugroun1, Hussein Daoud2, Manar E Abdel-Rahman3, Osama Hallak2, Efehi Igbinomwanhia2, Alejandro Sanchez2, Adhir Shroff4, Lloyd W Klein5. 1. Wayne State University, Detroit, MI, United States of America. Electronic address: abugroun@live.com. 2. Advocate Illinois Masonic Medical Center, Chicago, IL, United States of America. 3. Qatar University, College of Health Sciences-QU Health, Department of Public Health, Doha, Qatar. 4. University of Illinois-Chicago, Chicago, IL, United States of America. 5. Advocate Illinois Masonic Medical Center, Chicago, IL, United States of America; University of California, San Francisco, San Francisco, CA, United States of America.
Abstract
BACKGROUND: To evaluate the trends in complication rates following transcatheter aortic valve replacement (TAVR) procedures according to the type of vascular approach (endovascular vs. transapical) in a large US population sample. METHODS: The National Inpatient Sample (NIS) was queried for all patients diagnosed with aortic stenosis who underwent a TAVR procedure in the United States during the years 2012-2016. Outcomes assessed were peri-procedural mortality, cardiac, and non-cardiac complications. Hospitalization outcomes were modeled using logistic regression for binary outcomes and generalized linear models for continuous outcomes. RESULTS: There were 97,320 endovascular-TAVR patients and 11,140 transapical-TAVR patients. The mean age was 80.8 years (standard error of the mean: ± 0.1). Most patients were males (53.7%) and Caucasian (87.1%). On multivariate analysis, after adjusting for age, gender, comorbidities, as well as hospital factors, patients with the transapical approach had a higher risk for mortality and adverse outcomes. Among the endovascular-TAVR group, national trends showed a diminishing incidence of procedural mortality (incidence rate ratio [IRR] 0.77; 95% CI: 0.72-0.84, p < 0.001), stroke (IRR 0.80; 95% CI: 0.73-0.87, p < 0.001), and all secondary outcomes, but no significant change in myocardial infarction. In contrast, most transapical-TAVR related procedural complications remained unchanged over time, except for a significant decrease in stroke, acute respiratory failure and need for pacemaker insertion. CONCLUSION: National trends show a steady increase in the number of endovascular-TAVR procedures with a concurrent decrease in procedural complications.
BACKGROUND: To evaluate the trends in complication rates following transcatheter aortic valve replacement (TAVR) procedures according to the type of vascular approach (endovascular vs. transapical) in a large US population sample. METHODS: The National Inpatient Sample (NIS) was queried for all patients diagnosed with aortic stenosis who underwent a TAVR procedure in the United States during the years 2012-2016. Outcomes assessed were peri-procedural mortality, cardiac, and non-cardiac complications. Hospitalization outcomes were modeled using logistic regression for binary outcomes and generalized linear models for continuous outcomes. RESULTS: There were 97,320 endovascular-TAVR patients and 11,140 transapical-TAVR patients. The mean age was 80.8 years (standard error of the mean: ± 0.1). Most patients were males (53.7%) and Caucasian (87.1%). On multivariate analysis, after adjusting for age, gender, comorbidities, as well as hospital factors, patients with the transapical approach had a higher risk for mortality and adverse outcomes. Among the endovascular-TAVR group, national trends showed a diminishing incidence of procedural mortality (incidence rate ratio [IRR] 0.77; 95% CI: 0.72-0.84, p < 0.001), stroke (IRR 0.80; 95% CI: 0.73-0.87, p < 0.001), and all secondary outcomes, but no significant change in myocardial infarction. In contrast, most transapical-TAVR related procedural complications remained unchanged over time, except for a significant decrease in stroke, acute respiratory failure and need for pacemaker insertion. CONCLUSION: National trends show a steady increase in the number of endovascular-TAVR procedures with a concurrent decrease in procedural complications.
Authors: Victor Mauri; Mohamed Abdel-Wahab; Sabine Bleiziffer; Verena Veulemans; Alexander Sedaghat; Matti Adam; Georg Nickenig; Malte Kelm; Holger Thiele; Stephan Baldus; Tanja K Rudolph Journal: Clin Res Cardiol Date: 2021-11-09 Impact factor: 6.138
Authors: Margaret Ellenora Wiggins; Catherine Dion; Erin Formanski; Anis Davoudi; Shawna Amini; Kenneth M Heilman; Dana Penney; Randall Davis; Cynthia W Garvan; George J Arnaoutakis; Patrick Tighe; David J Libon; Catherine C Price Journal: Explor Med Date: 2021-04-30