title: Mechanical circulatory support devices and transcatheter aortic valve implantation (from the National Inpatient Sample).
abstract: High-risk surgical patients undergoing transcatheter aortic valve implantation (TAVI) represent an emerging population, which may benefit from short-term use of mechanical circulatory support (MCS) devices. The aim of this study was to determine the practice and inhospital outcomes of MCS utilization in patients undergoing TAVI. We analyzed data from Nationwide Inpatient Sample (2011 and 2012) using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. A total of 1,794 TAVI procedures (375 hospitals in the United States) were identified of which 190 (10.6%) used an MCS device (MCS group) and 1,604 (89.4%) did not (non-MCS group). The use of MCS devices with TAVI was associated with significant increase in the inhospital mortality (14.9% vs 3.5%, p <0.01). The mean length (11.8 ± 0.8 vs 8.1 ± 0.2 days, p <0.01) and cost ($68,997 ± 3,656 vs $55,878 ± 653, p = 0.03) of hospitalization were also significantly greater in the MCS group. Ventricular fibrillation arrest, transapical access for TAVI, and cardiogenic shock were the most significant predictors of MCS use during TAVI. In the multivariate model, use of any MCS device was found to be an independent predictor of increased mortality (odds ratio 3.5, 95% confidence interval 2.6 to 4.6, p <0.0001) and complications (odds ratio 3.3, 95% confidence interval 2.8 to 3.9, p <0.0001). The propensity score-matched analysis also showed a similar result. In conclusion, the unacceptably high rates of mortality and complications coupled with a significant increase in the length and cost of hospitalization should raise concerns about utility of MCS devices during TAVI in this prohibitive surgical risk population.
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Internal Medicine Department, Western Reserve Health Education, Youngstown, Ohio.
authors.forename: Samir V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Public Health Department, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Interventional Cardiology Department, The Everett Clinic, Everett, Washington.
authors.forename: Abeel
authors.initials: A
authors.lastname: Mangi
authors.affiliation: Interventional Cardiology Department, The Everett Clinic, Everett, Washington.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: Interventional Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.com.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D014481:United States / Q000453:epidemiology; D055815:Young Adult