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Outcomes of urgent versus nonurgent transcatheter aortic valve replacement.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2020 Jul; Vol. 96 (1), pp. 189-195. Date of Electronic Publication: 2019 Oct 24. - Publication Year :
- 2020
-
Abstract
- Background: There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting.<br />Methods: The Nationwide Inpatient Sample (NIS) database years 2011-2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings.<br />Results: Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p = .001). The rates of in-hospital mortality among this group did not change during the study period (p = .713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69-0.89, p < .001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40-0.53 p < .001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59-0.82, p < .001), AKI (OR = 0.60; 95%CI: 0.56-0.64 p < .001), hemodialysis (OR = 0.67; 95%CI: 0.56-0.80 p < .001), major bleeding (OR = 0.94; 95%CI: 0.89-0.99 p = .045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p < .001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81-1.14, p = .636), vascular complications (OR = 1.07; 95%CI: 0.89-1.29, p = .492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84-1.01, p = .067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p = .033), women (p < .001), chronic kidney disease (p = .001), heart failure (p < .001), and liver disease (p = .003).<br />Conclusion: In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.<br /> (© 2019 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
Databases, Factual
Elective Surgical Procedures
Female
Hospital Mortality
Hospitalization
Humans
Inpatients
Male
Postoperative Complications mortality
Postoperative Complications therapy
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Aortic Valve surgery
Aortic Valve Stenosis surgery
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 96
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31647180
- Full Text :
- https://doi.org/10.1002/ccd.28563