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Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non-TAVR Centers.

Authors
  • Jack, Godly1
  • Arora, Sameer2
  • Strassle, Paula D3
  • Sitammagari, Kranthi4
  • Gangani, Kishorbhai5
  • Yeung, Michael6
  • Cavender, Matthew A6
  • O'Gara, Patrick T7
  • Vavalle, John P6
  • 1 Department of Internal Medicine University of North Carolina School of Medicine Chapel Hill NC.
  • 2 Center for Research and Population Health Lillington NC.
  • 3 Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill NC.
  • 4 Campbell University School of Osteopathic Medicine Lillington NC.
  • 5 Department of Internal Medicine Texas Health Arlington Memorial Hospital Arlington TX.
  • 6 Division of Cardiology University of North Carolina School of Medicine Chapel Hill NC.
  • 7 Division of Cardiovascular Medicine Brigham and Women's Hospital Harvard Medical School Boston MA.
Type
Published Article
Journal
Journal of the American Heart Association
Publisher
Ovid Technologies Wolters Kluwer -American Heart Association
Publication Date
Nov 19, 2019
Volume
8
Issue
22
Identifiers
DOI: 10.1161/JAHA.119.013794
PMID: 31718443
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Background Transcatheter aortic valve replacement (TAVR) has solidified the importance of a heart team and revolutionized patient selection for surgical aortic valve replacement (SAVR). It is unknown if hospital ability to offer TAVR impacts SAVR outcomes. We investigated outcomes after SAVR between TAVR and non-TAVR centers. Methods and Results Hospitalizations of patients aged ≥50 years, undergoing elective SAVR between January 2012 and September 2015, in the National Readmission Database (NRD) were included. Multivariable logistic, linear, and generalized logistic regression models were used to adjust for patient and hospital characteristics and estimate association between undergoing SAVR at a TAVR center, compared with a non-TAVR center. The association between TAVR volumes and these outcomes were also assessed. SAVR hospitalizations (n = 32 198) were identified; 22 066 (69%) at TAVR and 10 132 (31%) at non-TAVR centers. SAVRs at TAVR centers had lower odds of inpatient mortality (odds ratio 0.67, 95% CI 0.55-0.82) and discharge to skilled nursing facility (odds ratio 0.92, 95% CI 0.85-0.99), compared with non-TAVR centers. There was no difference in LOS (change in estimate -0.09, 95% CI -0.26 to 0.08) or 30-day re-admission (odds ratio 0.95, 95% CI 0.88-1.03). SAVRs performed at the highest TAVR volume centers had the lowest inpatient mortality, compared with non-TAVR centers (odds ratio 0.43 95% CI 0.29-0.63). Conclusions Patients undergoing SAVR at TAVR centers are more likely to survive and have better discharge disposition than patients undergoing SAVR at non-TAVR centers. Whether this represents benefits of a heart-team approach to care or differences in patient selection for SAVR when TAVR is unavailable requires further study.

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