Elsevier

The American Journal of Cardiology

Volume 183, 15 November 2022, Pages 78-84
The American Journal of Cardiology

In-Hospital Outcomes of Surgical Aortic Valve Replacement at Transcatheter Valve Implantation Centers

https://doi.org/10.1016/j.amjcard.2022.08.003Get rights and content

The availability of transcatheter aortic valve implantation (TAVI) has led to the development of a multidisciplinary team, the “heart team,” at institutions offering both TAVI and surgical aortic valve replacement (SAVR). Whether this approach has improved in-hospital outcomes in patients who underwent SAVR at institutions offering TAVI versus those not offering TAVI is largely unknown. The National Inpatient Sample (2011 to 2018) was used to study trends in visits for SAVR and in-hospital outcomes at TAVI and non-TAVI centers. Survey estimation commands were used to determine weighted national estimates. There were 559,365 inpatient visits during 2011 to 2018 for aortic valve replacement, with 65.9 ± 0.8% and 34.0 ± 0.8% at TAVI and non-TAVI centers, respectively. Patients who underwent SAVR at TAVI hospitals had more co-morbidities and were less likely to receive mechanical prosthesis (24.7 ± 0.5% vs 35.5 ± 0.6%). Adjusted in-hospital mortality was lower among any SAVR (odds ratio 0.84, 95% confidence interval 0.75 to 0.94) and isolated SAVR (odds ratio 0.83, 95% confidence interval 0.70 to 0.98) recipients at TAVI centers. There was no difference in the incidence of stroke, permanent pacemaker placement, and acute kidney injury after SAVR in TAVI and non-TAVI centers. Although patients who underwent SAVR at TAVI centers had more co-morbidities, in-hospital mortality was lower at TAVI centers than non-TAVI centers. This may be attributable to several factors, including but not limited to experience, resource availability, and operative volumes and the use of the heart team.

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Methods

We performed a retrospective analysis using the NIS for the years 2011 to 2018. The NIS is the largest publicly available all-payer inpatient database in the United States, designed by the Agency of Healthcare Research and Quality (AHRQ) to produce national estimates of inpatient utilization and outcomes. The diagnosis and procedures performed during inpatient visits were identified using the International Classification of Disease (ICD), Ninth (ICD-9) and ICD Tenth (ICD-10) Revision codes.

Results

The characteristics and co-morbidities of patients who underwent SAVR at TAVI and non-TAVI-performing hospitals are summarized in Table 1. The majority of SAVR were performed at TAVI hospitals (65.9 ± 0.8%) during 2011 to 2018. Furthermore, the number of SAVR performed at TAVI hospitals increased, and the number of SAVR at non-TAVI decreased from 2011 to 2018 (Supplementary Figure 1).

At TAVI hospitals, 75.3 ± 0.5% received a bAVR, whereas 24.7 ± 0.5% underwent mAVR compared with patients at

Discussion

In the present study, we evaluated trends in the use of valve type and in-hospital outcomes after SAVR at TAVI and non-TAVI hospitals in the contemporary population in the United States. Patients who underwent SAVR at TAVI hospitals had a lower in-hospital mortality, despite more co-morbidities, than those patients who underwent SAVR at non-TAVI hospitals.

We found several differences in characteristics of patients who underwent SAVR at TAVI hospitals compared with non-TAVI hospitals. In

Disclosures

The authors have no conflicts of interest to declare.

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