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Utilization and outcomes of transcatheter aortic valve replacement in the United States shortly after device approval.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2017 Nov 01; Vol. 90 (5), pp. 830-838. Date of Electronic Publication: 2017 Mar 22. - Publication Year :
- 2017
-
Abstract
- Objective: The objective of this study was to assess the national uptake of TAVR, associated in-hospital outcomes, and the effect of procedural experience on outcomes in the first two years following device approval.<br />Background: Transcatheter aortic valve replacement (TAVR) is a newly established therapy for high-risk patients with severe aortic stenosis. Evaluating the manner in which TAVR has disseminated into real-world practice is essential for understanding its impact on population health.<br />Methods and Results: We identified patients undergoing TAVR from the National Inpatient Sample from January 2012 through December 2013. During this period, an estimated 21,185 cases were performed in the United States. Mean age was 81.1 years, 50.8% were male, 86.5% were Caucasian, and 89.6% were Medicare patients. The number of TAVRs performed and of hospitals performing the procedure nationally grew linearly throughout the study period. The most frequent complications included bleeding (26.9%), respiratory failure (19.3%), and renal/metabolic issues (17.2%). Median hospital length of stay was 6 days (IQR 4-10). In-hospital mortality was estimated to be 4.9%. A majority of cases were performed in large (80.8%) and in urban teaching (87%) hospitals. In the first year post-market approval, prior institutional experience with TAVR was associated with significantly reduced risk-adjusted, in-hospital mortality (OR 0.82 per 25 additional TAVRs performed, CI 0.70-0.951, Pā=ā0.009).<br />Conclusions: Following device approval, the number of TAVRs and hospitals performing TAVR grew dramatically. Procedural complications were frequent and in-hospital mortality was approximately 4.9%. Finally, increased procedural experience was strongly associated with a reduction in inpatient mortality. © 2017 Wiley Periodicals, Inc.<br /> (© 2017 Wiley Periodicals, Inc.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Chi-Square Distribution
Clinical Competence
Databases, Factual
Female
Heart Valve Prosthesis statistics & numerical data
Hospital Mortality
Humans
Learning Curve
Length of Stay
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Postoperative Complications etiology
Product Surveillance, Postmarketing
Registries
Risk Factors
Severity of Illness Index
Time Factors
Transcatheter Aortic Valve Replacement instrumentation
Transcatheter Aortic Valve Replacement mortality
Transcatheter Aortic Valve Replacement trends
Treatment Outcome
United States
United States Food and Drug Administration
Aortic Valve surgery
Aortic Valve Stenosis surgery
Device Approval
Practice Patterns, Physicians' trends
Process Assessment, Health Care trends
Transcatheter Aortic Valve Replacement statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 90
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 28326675
- Full Text :
- https://doi.org/10.1002/ccd.27018