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Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012.
JACC Cardiovasc Interv. 2016 Mar 28; 9(6):578-85.JC

Abstract

OBJECTIVES

The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting.

BACKGROUND

TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients.

METHODS

New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk.

RESULTS

The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]).

CONCLUSIONS

TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients.

Authors+Show Affiliations

School of Public Health, University at Albany, State University of New York, Albany, New York. Electronic address: elh03@health.state.ny.us.School of Public Health, University at Albany, State University of New York, Albany, New York.Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming.Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut.Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York.Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts.University of Nebraska Medical Center, Omaha, Nebraska.Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, New York.Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York.Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

27013157

Citation

Hannan, Edward L., et al. "Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012." JACC. Cardiovascular Interventions, vol. 9, no. 6, 2016, pp. 578-85.
Hannan EL, Samadashvili Z, Stamato NJ, et al. Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. JACC Cardiovasc Interv. 2016;9(6):578-85.
Hannan, E. L., Samadashvili, Z., Stamato, N. J., Lahey, S. J., Wechsler, A., Jordan, D., Sundt, T. M., Gold, J. P., Ruiz, C. E., Ashraf, M. H., & Smith, C. R. (2016). Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. JACC. Cardiovascular Interventions, 9(6), 578-85. https://doi.org/10.1016/j.jcin.2015.12.022
Hannan EL, et al. Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. JACC Cardiovasc Interv. 2016 Mar 28;9(6):578-85. PubMed PMID: 27013157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. AU - Hannan,Edward L, AU - Samadashvili,Zaza, AU - Stamato,Nicholas J, AU - Lahey,Stephen J, AU - Wechsler,Andrew, AU - Jordan,Desmond, AU - Sundt,Thoralf M,3rd AU - Gold,Jeffrey P, AU - Ruiz,Carlos E, AU - Ashraf,Mohammed H, AU - Smith,Craig R, PY - 2015/09/01/received PY - 2015/11/12/revised PY - 2015/12/17/accepted PY - 2016/3/26/entrez PY - 2016/3/26/pubmed PY - 2017/1/5/medline KW - mortality KW - surgical aortic valve replacement KW - transcatheter aortic valve implantation SP - 578 EP - 85 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 9 IS - 6 N2 - OBJECTIVES: The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. BACKGROUND: TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. METHODS: New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. RESULTS: The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). CONCLUSIONS: TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/27013157/Utilization_and_1_Year_Mortality_for_Transcatheter_Aortic_Valve_Replacement_and_Surgical_Aortic_Valve_Replacement_in_New_York_Patients_With_Aortic_Stenosis:_2011_to_2012_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(15)02003-8 DB - PRIME DP - Unbound Medicine ER -