1
|
Oettinger V, Kaier K, von Zur Mühlen C, Zehender M, Bode C, Beyersdorf F, Stachon P, Bothe W. Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement. Thorac Cardiovasc Surg 2024; 72:173-180. [PMID: 35917823 DOI: 10.1055/s-0042-1754352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Literature demonstrated that procedure volumes affect outcomes of patients undergoing transcatheter aortic valve implantation. We evaluated the outcomes of surgical aortic valve replacement. METHODS All isolated surgical aortic valve replacement procedures in Germany in 2017 were identified. Hospitals were divided into five groups from ≤25 (very low volume) until >100 (very high volume) annual procedures. RESULTS In 2017, 5,533 patients underwent isolated surgical aortic valve replacement. All groups were of comparable risk (logistic EuroSCORE, 5.12-4.80%) and age (66.6-68.1 years). In-hospital mortality and complication rates were lowest in the very high-volume group. Multivariable logistic regression analyses showed no significant volume-outcome relationship for in-hospital mortality, stroke, postoperative delirium, and mechanical ventilation > 48 hours. Regarding acute kidney injury, patients in the very high-volume group were at lower risk than those in the very low volume group (odds ratio [OR] = 0.53, p = 0.04). Risk factors for in-hospital mortality were previous cardiac surgery (OR = 5.75, p < 0.001), high-grade renal disease (glomerular filtration rate < 15 mL/min, OR = 5.61, p = 0.002), surgery in emergency cases (OR = 2.71, p = 0.002), and higher grade heart failure (NYHA [New York Heart Association] III/IV; OR = 1.80, p = 0.02). Risk factors for all four complication rates were atrial fibrillation and diabetes mellitus. CONCLUSION Patients treated in very low volume centers (≤25 operations/year) had a similar risk regarding in-hospital mortality and most complications compared with very high-volume centers (>100 operations/year). Only in the case of acute kidney injury, very high-volume centers showed better outcomes than very low volume centers. Therefore, surgical aortic valve replacement can be performed safely independent of case volume.
Collapse
Affiliation(s)
- Vera Oettinger
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiac and Vascular Surgery, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bothe
- Department of Cardiac and Vascular Surgery, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
2
|
Abudan AA, Vaidya VR, Tripathi B, Noseworthy PA, DeSimone DC, Egbe A, Arora S, Sridhar H, DeSimone CV, Mulpuru S, Deshmukh AJ. Burden of arrhythmia in hospitalized HIV patients. Clin Cardiol 2020; 44:66-77. [PMID: 33295667 PMCID: PMC7803370 DOI: 10.1002/clc.23506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background The improved life expectancy observed in patients living with human immunodeficiency virus (HIV) infection has made age‐related cardiovascular complications, including arrhythmias, a growing health concern. Hypothesis We describe the temporal trends in frequency of various arrhythmias and assess impact of arrhythmias on hospitalized HIV patients using the Nationwide Inpatient Sample (NIS). Methods Data on HIV‐related hospitalizations from 2005 to 2014 were obtained from the NIS database using International Classification of Diseases, 9th Revision (ICD‐9) codes. Data was further subclassified into hospitalizations with associated arrhythmias and those without. Baseline demographics and comorbidities were determined. Outcomes including in‐hospital mortality, cost of care, and length of stay were extracted. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for analysis. A multivariable analysis was performed to identify predictors of arrhythmias among hospitalized HIV patients. Results Among 2 370 751 HIV‐related hospitalizations identified, the overall frequency of any arrhythmia was 3.01%. Atrial fibrillation (AF) was the most frequent arrhythmia (2110 per 100 000). The overall frequency of arrhythmias increased over time by 108%, primarily due to a 132% increase in AF. Arrhythmias are more frequent among older males, lowest income quartile, and nonelective admissions. Patients with arrhythmias had a higher in‐hospital mortality rate (9.6%). In‐hospital mortality among patients with arrhythmias decreased over time by 43.8%. The cost of care and length of stay associated with arrhythmia‐related hospitalizations were mostly unchanged. Conclusions Arrhythmias are associated with significant morbidity and mortality in hospitalized HIV patients. AF is the most frequent arrhythmia in hospitalized HIV patients.
Collapse
Affiliation(s)
- Anas A Abudan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.,Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Byomesh Tripathi
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York, United States
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel C DeSimone
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States.,Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Egbe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Shilpkumar Arora
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital, New York, New York, United States
| | - Haarini Sridhar
- University of California, Berkeley, California, United States
| | | | - Siva Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Abhishek J Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
3
|
Tabata M, Kumamaru H, Ono A, Miyata H, Sato Y, Motomura N. The Association of In-Hospital Transcatheter Aortic Valve Replacement Availability on Outcomes of Surgical Aortic Valve Replacement in Elderly Patients. Circ J 2020; 84:1599-1604. [DOI: 10.1253/circj.cj-20-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, the University of Tokyo
| | - Aya Ono
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, the University of Tokyo
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University
| | | |
Collapse
|
4
|
Singh V, Savani GT, Mendirichaga R, Jonnalagadda AK, Cohen MG, Palacios IF. Frequency of Complications Including Death from Coronary Artery Bypass Grafting in Patients With Hepatic Cirrhosis. Am J Cardiol 2018; 122:1853-1861. [PMID: 30293650 DOI: 10.1016/j.amjcard.2018.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
Advanced liver disease is a risk factor for cardiac surgery. However, liver dysfunction is not included in cardiac risk assessment models. We sought to identify trends in utilization, complications, and outcomes of patients with cirrhosis who underwent coronary artery bypass graft surgery (CABG). Using the National Inpatient Sample database, we identified patients with cirrhosis who underwent CABG from 2002 to 2014. Propensity-score matching was used to identify differences in in-hospital mortality and postoperative complications in cirrhosis and noncirrhosis patients. We identified a total of 698,799 CABG admissions of which 2,231 (0.3%) had cirrhosis (mean age 63.6 ± 9.6 years, 74% men, 63% white, mean Charlson co-morbidity index 3.3 ± 1.8). Cardiopulmonary bypass was used in 71% of patients. Mean length of stay was 13.7 ± 11.4 days and hospitalization cost $67,744.6 ± 58,320.4. One or more complications occurred in 44% of cases. After propensity-score matching, patients with cirrhosis had a higher rate of complications (43.9% vs 38.93%; p < 0.001) and in-hospital mortality (7.2% vs 4.07%; p < 0.001) than noncirrhosis patients. On multivariate analysis, cirrhosis and ascites were associated with increased in-hospital mortality (odds ratio 2.87; 95% confidence intervals 2.37 to 3.48) and postoperative complications (odds ratio 5.11; 95% confidence intervals 3.88 to 6.72). In conclusion, patients with cirrhosis constitute a small portion of patients who underwent CABG in the United States but have a higher rate of complications and in-hospital mortality compared with noncirrhosis patients. In-hospital mortality remains high for this subset of patients but has decreased in recent years.
Collapse
Affiliation(s)
- Vikas Singh
- Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky.
| | - Ghanshyambhai T Savani
- Department of Medicine, Baystate Medical Center, University of Massachusetts, Springfield, Massachusetts
| | - Rodrigo Mendirichaga
- Division of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Anil K Jonnalagadda
- Department of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Massachusetts
| | - Igor F Palacios
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Mori M, Bin Mahmood SU, Geirsson A, Yun JJ, Cleman MW, Forrest JK, Mangi AA. Trends in volume and risk profiles of patients undergoing isolated surgical and transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:E337-E342. [DOI: 10.1002/ccd.27855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Makoto Mori
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| | | | - Arnar Geirsson
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| | - James J. Yun
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| | - Michael W. Cleman
- Section of Cardiovascular MedicineYale University School of Medicine New Haven Connecticut
| | - John K. Forrest
- Section of Cardiovascular MedicineYale University School of Medicine New Haven Connecticut
| | - Abeel A. Mangi
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| |
Collapse
|
6
|
Comparison of Utilization Trends, Indications, and Complications of Endomyocardial Biopsy in Native Versus Donor Hearts (from the Nationwide Inpatient Sample 2002 to 2014). Am J Cardiol 2018; 121:356-363. [PMID: 29197471 DOI: 10.1016/j.amjcard.2017.10.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 01/28/2023]
Abstract
Native heart endomyocardial biopsy (NH-EMB) is an infrequently performed procedure. The objective of this study is to describe utilization trends, indications, and complications associated with NH-EMB in the United States and compare them with transplanted heart endomyocardial biopsy (TH-EMB). Using the Healthcare Cost and Utilization Project National Inpatient Sample database, we identified 71,105 adult patients undergoing EMB in the inpatient setting in participating hospitals from 2002 to 2014. A total of 20,770 (29%) were performed on NHs (mean age 52.2 ± 15.3, 61% men). Approximately half of patients were white and mean Charlson co-morbidity index was 1.97 ± 1.6. Common indications for NH-EMB included a suspected primary cardiomyopathy (disorder confined to the myocardium), heart failure without cardiogenic shock, and acute myocarditis. Less common indications included heart failure with cardiogenic shock, unexplained heart failure with ventricular tachycardia or high-degree atrioventricular block, and cardiac neoplasms. Complications included pericardial effusion (3.8%), third-degree atrioventricular block (2.7%), vascular complications (1.9%), and deep venous thrombosis (3.5%), in others. Predictors of complications included presence of a cardiac malignant neoplasm, use of hemodynamic support, heart failure with ventricular tachyarrhythmias, and female gender. Compared with NH-EMB, TH-EMB was associated with lower rates of pericardial effusion, third-degree atrioventricular block, ventricular tachyarrhythmias requiring cardioversion, and higher rates of deep venous thrombosis, infections, and pneumothorax. NH-EMB utilization is low in the United States and constitutes less than 1/3 of all EMBs performed.
Collapse
|
7
|
Costa C, Teles RC, Brito J, Neves JP, Gabriel HM, Abecassis M, Ribeiras R, Abecasis J, Nolasco T, Furstenau MDC, Vale N, Tralhão A, Madeira S, Mesquita J, Saraiva C, Calé R, Almeida M, Aleixo A, Mendes M. Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience. Rev Port Cardiol 2017; 36:809-818. [PMID: 29153618 DOI: 10.1016/j.repc.2016.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/09/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. METHODS The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. RESULTS TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients' outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). CONCLUSIONS The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner.
Collapse
Affiliation(s)
- Cátia Costa
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; Serviço de Cardiologia, Hospital Santarém, Santarém, Portugal.
| | - Rui Campante Teles
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal
| | - João Brito
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - José Pedro Neves
- Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | | | - Miguel Abecassis
- Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - Regina Ribeiras
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - João Abecasis
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal
| | - Tiago Nolasco
- Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | | | - Nélson Vale
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - António Tralhão
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - Sérgio Madeira
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - João Mesquita
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - Carla Saraiva
- Serviço de Imagiologia, Hospital S. Francisco Xavier (CHLO), Lisboa, Portugal
| | - Rita Calé
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; Serviço de Cardiologia, Hospital Garcia Orta, Almada, Portugal
| | - Manuel Almeida
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal
| | - Ana Aleixo
- CEDOC, Nova Medical School, Lisboa, Portugal
| | - Miguel Mendes
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| |
Collapse
|
8
|
Costa C, Teles RC, Brito J, Neves JP, Gabriel HM, Abecassis M, Ribeiras R, Abecasis J, Nolasco T, Furstenau MDC, Vale N, Tralhão A, Madeira S, Mesquita J, Saraiva C, Calé R, Almeida M, Aleixo A, Mendes M. Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Abstract
BACKGROUND The immediate effect of aortic valve replacement (AVR) for aortic stenosis on perioperative myocardial function is unclear. Left ventricular (LV) function may be impaired by cardioplegia-induced myocardial arrest and ischemia-reperfusion injury, especially in patients with LV hypertrophy. Alternatively, LV function may improve when afterload is reduced after AVR. The right ventricle (RV), however, experiences cardioplegic arrest without benefiting from improved loading conditions. Which of these effects on myocardial function dominate in patients undergoing AVR for aortic stenosis has not been thoroughly explored. Our primary objective is thus to characterize the effect of intraoperative events on LV function during AVR using echocardiographic measures of myocardial deformation. Second, we evaluated RV function. METHODS In this supplementary analysis of 100 patients enrolled in a clinical trial (NCT01187329), 97 patients underwent AVR for aortic stenosis. Of these patients, 95 had a standardized intraoperative transesophageal echocardiographic examination of systolic and diastolic function performed before surgical incision and repeated after chest closure. Echocardiographic images were analyzed off-line for global longitudinal myocardial strain and strain rate using 2D speckle-tracking echocardiography. Myocardial deformation assessed at the beginning of surgery was compared with the end of surgery using paired t tests corrected for multiple comparisons. RESULTS LV volumes and arterial blood pressure decreased, and heart rate increased at the end of surgery. Echocardiographic images were acceptable for analysis in 72 patients for LV strain, 67 for LV strain rate, and 54 for RV strain and strain rate. In 72 patients with LV strain images, 9 patients required epinephrine, 22 required norepinephrine, and 2 required both at the end of surgery. LV strain did not change at the end of surgery compared with the beginning of surgery (difference: 0.7 [97.6% confidence interval, -0.2 to 1.5]%; P = 0.07), whereas LV systolic strain rate improved (became more negative) (-0.3 [-0.4 to -0.2] s; P < 0.001). In contrast, RV systolic strain worsened (became less negative) at the end of surgery (difference: 4.6 [3.1 to 6.0]%; P < 0.001) although RV systolic strain rate was unchanged (0.0 [97.6% confidence interval, -0.1 to 0.1]; P = 0.83). CONCLUSIONS LV function improved after replacement of a stenotic aortic valve demonstrated by improved longitudinal strain rate. In contrast, RV function, assessed by longitudinal strain, was reduced.
Collapse
|
10
|
Singh V, Rodriguez AP, Thakkar B, Patel NJ, Ghatak A, Badheka AO, Alfonso CE, de Marchena E, Sakhuja R, Inglessis-Azuaje I, Palacios I, Cohen MG, Elmariah S, O'Neill WW. Comparison of Outcomes of Transcatheter Aortic Valve Replacement Plus Percutaneous Coronary Intervention Versus Transcatheter Aortic Valve Replacement Alone in the United States. Am J Cardiol 2016; 118:1698-1704. [PMID: 27665205 DOI: 10.1016/j.amjcard.2016.08.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) has emerged as a less-invasive therapeutic option for high surgical risk patients with aortic stenosis and coronary artery disease. The aim of this study was to determine the outcomes of TAVR when performed with PCI during the same hospitalization. We identified patients using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2011 and 2013. A total of 22,344 TAVRs were performed between 2011 and 2013. Of these, 21,736 (97.3%) were performed without PCI (TAVR group) while 608 (2.7%) along with PCI (TAVR + PCI group). Among the TAVR + PCI group, 69.7% of the patients had single-vessel, 22.2% had 2-vessel, and 1.6% had 3-vessel PCI. Drug-eluting stents were more commonly used than bare-metal stents (72% vs 28%). TAVR + PCI group witnessed significantly higher rates of mortality (10.7% vs 4.6%) and complications: vascular injury requiring surgery (8.2% vs 4.2%), cardiac (25.4% vs 18.6%), respiratory (24.6% vs 16.1%), and infectious (10.7% vs 3.3%), p <0.001% for all, compared with the TAVR group. The mean length of hospital stay and cost of hospitalization were also significantly higher in the TAVR + PCI group. The propensity score-matched analysis yielded similar results. In conclusion, performing PCI along with TAVR during the same hospital admission is associated with higher mortality, complications, and cost compared with TAVR alone. Patients would perhaps be better served by staged PCI before TAVR.
Collapse
Affiliation(s)
- Vikas Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Alex P Rodriguez
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Nileshkumar J Patel
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Abhijit Ghatak
- Cardiology Department, Southwest Heart, Las Cruces, New Mexico
| | - Apurva O Badheka
- Cardiovascular Division, The Everett Clinic, Everett, Washington
| | - Carlos E Alfonso
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo de Marchena
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Rahul Sakhuja
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ignacio Inglessis-Azuaje
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Igor Palacios
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Sammy Elmariah
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
11
|
Singh V, Patel NJ, Rodriguez AP, Shantha G, Arora S, Deshmukh A, Cohen MG, Grines C, De Marchena E, Badheka A, Ghatak A. Percutaneous Coronary Intervention in Patients With End-Stage Liver Disease. Am J Cardiol 2016; 117:1729-34. [PMID: 27103158 DOI: 10.1016/j.amjcard.2016.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 12/22/2022]
Abstract
The objective of our study was to assess patients with end-stage liver disease undergoing percutaneous coronary intervention (PCI) and determine the rates and trend of complications and in-hospital outcomes. Data were obtained from the Nationwide Inpatient Sample 2005 to 2012. We identified all PCIs performed in patients with diagnosis of cirrhosis during the study period by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Preventable procedural complications were identified by Patient Safety Indicators. Propensity scoring method was used to establish matched cohorts to control for imbalances and account for differences that may have influenced treatment outcomes. A total of 1,051,242 PCIs were performed during the study period, of these, 122,342 were done on subjects with a formal diagnosis of cirrhosis. Bare-metal stents (BMS) were more likely to be used in patients who presented with ST-elevation myocardial infarction (19.73 vs 13.58, p <0.001), in cardiogenic shock (5.58, vs 2.81, p <0.001), or required intraaortic balloon pump (4.73 vs 2.38, p <0.001). The overall rate of complications was 7.1%, whereas the overall mortality rate over these years was 3.63%. On a propensity-matched analysis the mortality rate was 2 times higher for BMS (5.18 vs 2.35, p <0.001) compared with drug-eluting stents. PCI remains a safe and plausible option for patients with cirrhosis albeit riskier than for the general population. The use of BMS is associated with increased mortality and bleeding complications compared with drug-eluting stents which likely is representative of preferential use of BMS in patients with more advanced end-stage liver disease who are also likely to experience higher postprocedural complications.
Collapse
Affiliation(s)
- Vikas Singh
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Nileshkumar J Patel
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Alex P Rodriguez
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Ghanshyam Shantha
- Cardiovascular Division, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Shilpkumar Arora
- Cardiovascular Division, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York
| | - Abhishek Deshmukh
- Cardiovascular Division, Cardiology Department, Mayo Clinic, Rochester, Minnesota
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Cindy Grines
- Cardiovascular Division, Detroit Medical Center, Detroit, Michigan
| | - Eduardo De Marchena
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Apurva Badheka
- Cardiovascular Division, The Everett Clinic, Everett, Washington
| | - Abhijit Ghatak
- Cardiovascular Division, South West Heart, Las Cruces, New Mexico.
| |
Collapse
|
12
|
Hospital Volume and In-Hospital Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 117:1028-9. [PMID: 26796196 DOI: 10.1016/j.amjcard.2015.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/22/2022]
|