title: Transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with cirrhosis.
abstract: OBJECTIVE
  To compare the in-hospital outcomes in cirrhosis patients undergoing transcatheter aortic valve replacement (TAVR) versus those undergoing surgical aortic valve replacement (SAVR).
  
  
  BACKGROUND
  Over the last 10 years, TAVR has emerged as a therapeutic option for treating severe aortic stenosis in high-risk patients. Cirrhosis patients have a high risk of operative morbidity and mortality while undergoing cardiac surgery. This study's hypothesis was that TAVR is a safer alternative compared to SAVR in cirrhosis patients.
  
  
  METHODS
  The study population was derived from the National Inpatient Sample (NIS) for the years 2011-2012 using ICD-9-CM procedure codes 35.21 and 35.22 for SAVR, and 35.05 and 35.06 for TAVR. Patients <50 years of age and those who concomitantly underwent other valvular procedures were excluded. ICD-9-CM diagnosis codes were used to identify patients with liver cirrhosis, portal hypertension, and esophageal varices. Using propensity score matching, two matched cohorts were derived in which the outcomes were compared using appropriate statistical tests.
  
  
  RESULTS
  There were 30 patients in the SAVR and TAVR group each. Compared to the TAVR group, the patients in SAVR group had significantly higher rate of transfusion of whole blood or blood products (p = 0.037), longer mean postprocedural length of stay (p = 0.006), and nonsignificantly higher mean cost of hospitalization (p = 0.2), any complications rate (p = 0.09), and liver complications rate (p = 0.4). In-hospital mortality rate was same in the both the groups. No patients in the TAVR group required open-heart surgery or cardiopulmonary bypass.
  
  
  CONCLUSIONS
  TAVR could be a viable option for aortic valve replacement in cirrhosis patients.
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
authors.forename: Aashay
authors.initials: A
authors.lastname: Patel
authors.affiliation: Fairview Hospital, Cleveland, Ohio.
authors.forename: Bashar
authors.initials: B
authors.lastname: Mohamad
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: St. Vincent Charity Medical Center, Cleveland, Ohio.
authors.forename: Ronak
authors.initials: R
authors.lastname: Bhimani
authors.affiliation: Icahn School of Public Health at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: New York Medical College School of Public Health, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: New York Medical College at Westchester Medical Center, Valhalla, New York.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Solanki
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sonani
authors.affiliation: Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: Abeel
authors.initials: A
authors.lastname: Mangi
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: John
authors.initials: J
authors.lastname: Forrest
authors.affiliation: The Everett Clinic, Everett, Washington.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D001803:Blood Transfusion; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: cirrhosis; complications; hospital outcomes; surgical aortic valve replacement; transcatheter aortic valve replacement