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Changes in outcomes over time in intermediate-risk patients treated for severe aortic stenosis.

Authors
  • Khalil, Khalil N1, 2
  • Boukhris, Marouane3
  • Badreddine, Malek1, 2
  • Ben Ali, Walid2
  • Stevens, Louis-Mathieu1, 2
  • Masson, Jean-Bernard1, 3
  • Potvin, Jeannot1, 3
  • Gobeil, Jean-François3
  • Noiseux, Nicolas1, 2
  • Khairy, Paul4
  • Forcillo, Jessica1, 2
  • 1 Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada. , (Canada)
  • 2 Division of Cardiology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada. , (Canada)
  • 3 Department of Cardiac Surgery, Centre Hospitalier de Université de Montréal, Montréal, Canada. , (Canada)
  • 4 Department of Cardiology, Institut de Cardiologie de Montréal, Montréal, Canada. , (Canada)
Type
Published Article
Journal
Journal of Cardiac Surgery
Publisher
Wiley (Blackwell Publishing)
Publication Date
Dec 01, 2020
Volume
35
Issue
12
Pages
3422–3429
Identifiers
DOI: 10.1111/jocs.15063
PMID: 33016512
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The advent of transcatheter aortic valve replacement (TAVR) has changed the practice of treating patients with severe aortic stenosis (AS). Heart-Teams have improved their decision-making process to refer patients to the best and safest treatment. The evidence allowed centers to increase funding and TAVR volume and extend indications to different risk categories of patients. This study evaluates the outcomes of intermediate-risk patients treated for severe AS in an academic center. Between 2012 and 2019, 812 patients with AS underwent TAVR or surgical aortic valve replacement (SAVR). A propensity score-matching analytic strategy was used to balance groups and adjust for time periods. Outcomes were recorded according to the Society of Thoracic Surgeons Guidelines; the primary outcome being 30-day mortality and the secondary outcomes being perioperative course and complications. No difference in mortality was seen but complications differed: more postoperative transient ischemic attacks, permanent pacemaker implantations, and perivalvular leaks in the transcatheter group, while more acute kidney injuries, atrial fibrillation, delirium, postoperative infections and bleeding, tamponade and need for reoperation in the surgical group as well as a longer hospital length-of-stay. However, over the years, morbidities/mortality decreased for all patients treated for AS. Data showed an improvement in morbidities/mortality for intermediate-risk patients treated with SAVR or TAVR. Increased funding allowed for a higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare costs. By incorporating important metrics such as length-of-stay, readmission rates, and complications into decision-making, the Heart-Team can improve clinical outcomes, healthcare economics, and resource utilization. © 2020 Wiley Periodicals LLC.

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