National Trends of Outcomes in Transcatheter Aortic Valve Replacement (TAVR) Through Transapical Versus Endovascular Approach : From the National Inpatient Sample (NIS)
Copyright © 2020 Elsevier Inc. All rights reserved..
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.
| Errataetall: |
CommentIn: Cardiovasc Revasc Med. 2020 Aug;21(8):971-972. - PMID 32461048 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:21 |
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| Enthalten in: |
Cardiovascular revascularization medicine : including molecular interventions - 21(2020), 8 vom: 20. Aug., Seite 964-970 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Abugroun, Ashraf [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic stenosis |
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| Anmerkungen: |
Date Completed 19.01.2021 Date Revised 19.01.2021 published: Print-Electronic CommentIn: Cardiovasc Revasc Med. 2020 Aug;21(8):971-972. - PMID 32461048 Citation Status MEDLINE |
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| doi: |
10.1016/j.carrev.2020.05.010 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM311326056 |
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| 245 | 1 | 0 | |a National Trends of Outcomes in Transcatheter Aortic Valve Replacement (TAVR) Through Transapical Versus Endovascular Approach |b From the National Inpatient Sample (NIS) |
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| 500 | |a CommentIn: Cardiovasc Revasc Med. 2020 Aug;21(8):971-972. - PMID 32461048 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a CONCLUSION: National trends show a steady increase in the number of endovascular-TAVR procedures with a concurrent decrease in procedural complications | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Aortic stenosis | |
| 650 | 4 | |a Endovascular access | |
| 650 | 4 | |a Endovascular-TAVR | |
| 650 | 4 | |a TA-TAVR | |
| 650 | 4 | |a TAVR | |
| 650 | 4 | |a Transapical access | |
| 650 | 4 | |a Transapical-TAVR | |
| 650 | 4 | |a Transcatheter aortic valve replacement | |
| 700 | 1 | |a Daoud, Hussein |e verfasserin |4 aut | |
| 700 | 1 | |a Abdel-Rahman, Manar E |e verfasserin |4 aut | |
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| 700 | 1 | |a Igbinomwanhia, Efehi |e verfasserin |4 aut | |
| 700 | 1 | |a Sanchez, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Shroff, Adhir |e verfasserin |4 aut | |
| 700 | 1 | |a Klein, Lloyd W |e verfasserin |4 aut | |
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