title: Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database).
abstract: We hypothesized that the availability of a transcatheter aortic valve implantation (TAVI) program in hospitals impacts the overall management of patients with aortic valve disease and hence may also improve postprocedural outcomes of conventional surgical aortic valve replacement (SAVR). The aim of the present study was to compare the inhospital outcomes of SAVR in centers with versus without availability of a TAVI program in an unrestricted large nationwide patient population >50 years of age. SAVRs performed on patients aged >50 years were identified from the Nationwide Inpatient Sample (NIS) for the years 2011 and 2012 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. SAVR cases were divided into 2 categories: those performed at hospitals with a TAVI program (SAVR-TAVI) and those without (SAVR-non-TAVI). A total of 9,674 SAVR procedures were identified: 4,526 (46.79%) in the SAVR-TAVI group and 5,148 (53.21%) in SAVR-non-TAVI group. The mean age of the study population was 70.2 ± 0.1 years with majority (53%) of the patients aged >70 years. The mean Charlson's co-morbidity score for patients in SAVR-TAVI group was greater (greater percentage of patients were aged >80 years, had hypertension, congestive heart failure, renal failure, and peripheral arterial disease) than that of patients in SAVR-non-TAVI group (1.6 vs 1.4, p <0.001). The propensity score matching analysis showed a statistically significant lower inhospital mortality (1.25% vs 1.72%, p = 0.001) and complications rate (35.6% vs 37.3%, p = 0.004) in SAVR-TAVI group compared to SAVR-non-TAVI group. The mean length of hospital stay was similar in the 2 groups the cost of hospitalization was higher in the SAVR-TAVI group ($43,894 ± 483 vs $41,032 ± 473, p <0.0001). Having a TAVI program was a significant predictor of reduced mortality and complications rate after SAVR in multivariate analysis. In conclusion, this largest direct comparative analysis demonstrates that SAVRs performed in centers with a TAVI program are associated with significantly lower mortality and complications rates compared to those performed in centers without a TAVI program.
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Vikas
authors: V
authors: Singh
authors: Interventional Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.com.
authors: Apurva O
authors: AO
authors: Badheka
authors: Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio.
authors: Samir V
authors: SV
authors: Patel
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Nileshkumar J
authors: NJ
authors: Patel
authors: Epidemiology Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors: Badal
authors: B
authors: Thakkar
authors: Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors: Nilay
authors: N
authors: Patel
authors: Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors: Shilpkumar
authors: S
authors: Arora
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Nish
authors: N
authors: Patel
authors: Public Health Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Achint
authors: A
authors: Patel
authors: Epidemiology Department, New York Medical College, Valhalla, New York.
authors: Chirag
authors: C
authors: Savani
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Abhijit
authors: A
authors: Ghatak
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Sidakpal S
authors: SS
authors: Panaich
authors: Interventional Cardiology Department, The Everett Clinic, Everett, Washington.
authors: Sunny
authors: S
authors: Jhamnani
authors: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors: Abhishek
authors: A
authors: Deshmukh
authors: Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC.
authors: Ankit
authors: A
authors: Chothani
authors: Internal Medicine Department, Emory University School of Medicine, Atlanta, Georgia.
authors: Rajesh
authors: R
authors: Sonani
authors: Internal Medicine Department, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
authors: Aashay
authors: A
authors: Patel
authors: Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors: Parth
authors: P
authors: Bhatt
authors: Public Health Department, Texas A&M Medical Centre, College Station, Texas.
authors: Abhishek
authors: A
authors: Dave
authors: Internal Medicine Department, St. Vincent Charity Medical Centre, Cleveland, Ohio.
authors: Ronak
authors: R
authors: Bhimani
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Tamam
authors: T
authors: Mohamad
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Cindy
authors: C
authors: Grines
authors: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors: Michael
authors: M
authors: Cleman
authors: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors: John K
authors: JK
authors: Forrest
authors: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors: Abeel
authors: A
authors: Mangi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014481:United States