title: Percutaneous aortic balloon valvotomy in the United States: a 13-year perspective.
abstract: BACKGROUND
  We determined the contemporary trends of percutaneous aortic balloon valvotomy and its outcomes using the nation's largest hospitalization database. There has been a resurgence in the use of percutaneous aortic balloon valvotomy in patients at high surgical risk because of the development of less-invasive endovascular therapies.
  
  
  METHODS
  This is a cross-sectional study with time trends using the Nationwide Inpatient Sample database between the years 1998 and 2010. We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure code for valvotomy. Only patients aged more than 60 years with aortic stenosis were included. Primary outcome included in-hospital mortality, and secondary outcomes included procedural complications and length of hospital stay.
  
  
  RESULTS
  A total of 2127 percutaneous aortic balloon valvotomies (weighted n = 10,640) were analyzed. The use rate of percutaneous aortic balloon valvotomy increased by 158% from 12 percutaneous aortic balloon valvotomies per million elderly patients in 1998-1999 to 31 percutaneous aortic balloon valvotomies per million elderly patients in 2009-2010 in the United States (P < .001). The hospital mortality decreased by 23% from 11.5% in 1998-1999 to 8.8% in 2009-2010 (P < .001). Significant predictors of in-hospital mortality were the presence of increasing comorbidities (P = .03), unstable patient (P < .001), any complication (P < .001), and weekend admission (P = .008), whereas increasing operator volume was associated with significantly reduced mortality (P = .03). Patients who were admitted to hospitals with the highest procedure volume and the highest volume operators had a 51% reduced likelihood (P = .05) of in-hospital mortality when compared with those in hospitals with the lowest procedure volume and lowest volume operators.
  
  
  CONCLUSIONS
  This study comprehensively evaluates trends for percutaneous aortic balloon valvotomy in the United States and demonstrates the significance of operator and hospital volume on outcomes.
authors.affiliation: Detroit Medical Center, Detroit, Mich.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Staten Island University Hospital, Staten Island, NY.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Staten Island University Hospital, Staten Island, NY.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: UPMC Shadyside Hospital, Pittsburgh, Pa.
authors.forename: Kathan
authors.initials: K
authors.lastname: Mehta
authors.affiliation: University of Arkansas, Little Rock.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ghatak
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, Calif.
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Harit
authors.initials: H
authors.lastname: Desai
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Peeyush
authors.initials: P
authors.lastname: Grover
authors.affiliation: Detroit Medical Center, Detroit, Mich.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Mayo Clinic, Rochester, Minn.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Detroit Medical Center, Detroit, Mich.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.affiliation: Detroit Medical Center, Detroit, Mich.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, Calif.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Mayo Clinic, Rochester, Minn.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: University of Miami Miller School of Medicine, Miami, Fla.
authors.forename: Eduardo
authors.initials: E
authors.lastname: De Marchena
authors.affiliation: Henry Ford Hospital, Detroit, Mich. Electronic address: raj_ohm2000@yahoo.co.in.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States
keywords: Complications; Hospital stay; Mortality; Percutaneous balloon aortic valvotomy