Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers
Background Transcatheter aortic valve replacement (TAVR) has solidified the importance of a heart team and revolutionized patient selection for surgical aortic valve replacement (SAVR). It is unknown if hospital ability to offer TAVR impacts SAVR outcomes. We investigated outcomes after SAVR between...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.013794 |
| _version_ | 1811331997293871104 |
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| author | Godly Jack Sameer Arora Paula D. Strassle Kranthi Sitammagari Kishorbhai Gangani Michael Yeung Matthew A. Cavender Patrick T. O'Gara John P. Vavalle |
| author_facet | Godly Jack Sameer Arora Paula D. Strassle Kranthi Sitammagari Kishorbhai Gangani Michael Yeung Matthew A. Cavender Patrick T. O'Gara John P. Vavalle |
| author_sort | Godly Jack |
| collection | DOAJ |
| description | Background Transcatheter aortic valve replacement (TAVR) has solidified the importance of a heart team and revolutionized patient selection for surgical aortic valve replacement (SAVR). It is unknown if hospital ability to offer TAVR impacts SAVR outcomes. We investigated outcomes after SAVR between TAVR and non‐TAVR centers. Methods and Results Hospitalizations of patients aged ≥50 years, undergoing elective SAVR between January 2012 and September 2015, in the National Readmission Database (NRD) were included. Multivariable logistic, linear, and generalized logistic regression models were used to adjust for patient and hospital characteristics and estimate association between undergoing SAVR at a TAVR center, compared with a non‐TAVR center. The association between TAVR volumes and these outcomes were also assessed. SAVR hospitalizations (n = 32 198) were identified; 22 066 (69%) at TAVR and 10 132 (31%) at non‐TAVR centers. SAVRs at TAVR centers had lower odds of inpatient mortality (odds ratio 0.67, 95% CI 0.55–0.82) and discharge to skilled nursing facility (odds ratio 0.92, 95% CI 0.85–0.99), compared with non‐TAVR centers. There was no difference in LOS (change in estimate −0.09, 95% CI −0.26 to 0.08) or 30‐day re‐admission (odds ratio 0.95, 95% CI 0.88–1.03). SAVRs performed at the highest TAVR volume centers had the lowest inpatient mortality, compared with non‐TAVR centers (odds ratio 0.43 95% CI 0.29–0.63). Conclusions Patients undergoing SAVR at TAVR centers are more likely to survive and have better discharge disposition than patients undergoing SAVR at non‐TAVR centers. Whether this represents benefits of a heart‐team approach to care or differences in patient selection for SAVR when TAVR is unavailable requires further study. |
| first_indexed | 2024-04-13T16:29:21Z |
| format | Article |
| id | doaj.art-ff2c10dab2be4c26acc45fa72bf7783f |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:29:21Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ff2c10dab2be4c26acc45fa72bf7783f2022-12-22T02:39:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-11-0182210.1161/JAHA.119.013794Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR CentersGodly Jack0Sameer Arora1Paula D. Strassle2Kranthi Sitammagari3Kishorbhai Gangani4Michael Yeung5Matthew A. Cavender6Patrick T. O'Gara7John P. Vavalle8Department of Internal Medicine University of North Carolina School of Medicine Chapel Hill NCCenter for Research and Population Health Lillington NCDepartment of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill NCCampbell University School of Osteopathic Medicine Lillington NCDepartment of Internal Medicine Texas Health Arlington Memorial Hospital Arlington TXDivision of Cardiology University of North Carolina School of Medicine Chapel Hill NCDivision of Cardiology University of North Carolina School of Medicine Chapel Hill NCDivision of Cardiovascular Medicine Brigham and Women's Hospital Harvard Medical School Boston MADivision of Cardiology University of North Carolina School of Medicine Chapel Hill NCBackground Transcatheter aortic valve replacement (TAVR) has solidified the importance of a heart team and revolutionized patient selection for surgical aortic valve replacement (SAVR). It is unknown if hospital ability to offer TAVR impacts SAVR outcomes. We investigated outcomes after SAVR between TAVR and non‐TAVR centers. Methods and Results Hospitalizations of patients aged ≥50 years, undergoing elective SAVR between January 2012 and September 2015, in the National Readmission Database (NRD) were included. Multivariable logistic, linear, and generalized logistic regression models were used to adjust for patient and hospital characteristics and estimate association between undergoing SAVR at a TAVR center, compared with a non‐TAVR center. The association between TAVR volumes and these outcomes were also assessed. SAVR hospitalizations (n = 32 198) were identified; 22 066 (69%) at TAVR and 10 132 (31%) at non‐TAVR centers. SAVRs at TAVR centers had lower odds of inpatient mortality (odds ratio 0.67, 95% CI 0.55–0.82) and discharge to skilled nursing facility (odds ratio 0.92, 95% CI 0.85–0.99), compared with non‐TAVR centers. There was no difference in LOS (change in estimate −0.09, 95% CI −0.26 to 0.08) or 30‐day re‐admission (odds ratio 0.95, 95% CI 0.88–1.03). SAVRs performed at the highest TAVR volume centers had the lowest inpatient mortality, compared with non‐TAVR centers (odds ratio 0.43 95% CI 0.29–0.63). Conclusions Patients undergoing SAVR at TAVR centers are more likely to survive and have better discharge disposition than patients undergoing SAVR at non‐TAVR centers. Whether this represents benefits of a heart‐team approach to care or differences in patient selection for SAVR when TAVR is unavailable requires further study.https://www.ahajournals.org/doi/10.1161/JAHA.119.013794aortic valve replacementaortic valve stenosistranscatheter aortic valve implantation |
| spellingShingle | Godly Jack Sameer Arora Paula D. Strassle Kranthi Sitammagari Kishorbhai Gangani Michael Yeung Matthew A. Cavender Patrick T. O'Gara John P. Vavalle Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic valve replacement aortic valve stenosis transcatheter aortic valve implantation |
| title | Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers |
| title_full | Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers |
| title_fullStr | Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers |
| title_full_unstemmed | Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers |
| title_short | Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non‐TAVR Centers |
| title_sort | differences in inpatient outcomes after surgical aortic valve replacement at transcatheter aortic valve replacement tavr and non tavr centers |
| topic | aortic valve replacement aortic valve stenosis transcatheter aortic valve implantation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.013794 |
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