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Kermanshahchi J, Thind B, Davoodpour G, Hirsch M, Chen J, Reddy AJ, Yu Z, Falkenstein BE, Javidi D. Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR): A Review on the Length of Stay, Cost, Comorbidities, and Procedural Complications. Cureus 2024; 16:e54435. [PMID: 38510891 PMCID: PMC10951673 DOI: 10.7759/cureus.54435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
This review provides an in-depth analysis of the effect of length of stay (LOS), comorbidities, and procedural complications on the cost-effectiveness of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR). We found that the average LOS was shorter for patients undergoing TAVR, contributing to lower average costs associated with the procedure, although the LOS varied between patients due to the severity of illness and comorbidities present. TAVR has also been found to improve the quality of life for patients receiving aortic valve replacement compared to SAVR. Although TAVR has a lower rate of most post-operative complications caused by SAVR, such as bleeding and cardiac complications, TAVR shows an increased rate of permanent pacemaker (PPM) implantation due to mechanical trauma on the heart's conduction system. In addition, our findings suggest that the cost-effectiveness of each procedure varies based on the types of valve, the patient history of other medical conditions, and the procedural methods. Our findings show that TAVR is preferred over SAVR in terms of cost-effectiveness across a variety of patients with other coexisting medical conditions, including cancer, advanced kidney disease, cirrhosis, diabetes mellitus, and bundle branch block. TAVR also appears to be superior to SAVR with fewer post-operative complications. However, TAVR appears to have a higher rate of PPM implantation rates as compared to SAVR. The comorbidities of the valve recipient must be considered when deciding whether to use TAVR or SAVR as cost-effectiveness varies with the patient background.
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Affiliation(s)
| | - Birpartap Thind
- Medicine, California University of Science and Medicine, Colton, USA
| | | | - Megan Hirsch
- Medicine, California University of Science and Medicine, Colton, USA
| | - Jeff Chen
- Medicine, California University of Science and Medicine, Colton, USA
| | - Akshay J Reddy
- Medicine, California University of Science and Medicine, Colton, USA
| | - Zeyu Yu
- College of Medicine, California Health Sciences University, Clovis, USA
| | | | - Daryoush Javidi
- Medical Education, California University of Science and Medicine, Colton, USA
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Rahman MU, Amritphale A, Kumar S, Trice C, Awan GM, Omar BA. Assessment of independent clinical predictors of early readmission after percutaneous endoluminal left atrial appendage closure with the Watchman device using National Readmission Database. Int J Cardiol 2021; 343:21-26. [PMID: 34481838 DOI: 10.1016/j.ijcard.2021.08.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Percutaneous endoluminal left atrial appendage closure (pLAAC) procedure has been used to prevent strokes in patients who are not eligible for long-term prophylactic anticoagulation. Since its approval, multiple studies have looked at its efficacy with comparable outcomes to anticoagulation, the current standard of care. OBJECTIVES To assess the readmission rate and determine the factors associated with readmission after the endocardial pLAAC procedure using the Watchman device. METHODS Data was obtained from the National Readmission Database (NRD), and we used SPSS software to determine statistically significant clinical predictors affecting readmission after implantation of the Watchman device at 30 days. RESULTS The rate of readmission was found to be 9.2%. The true median cost of index hospitalization for the total population in the study was found to be [median (interquartile range = IQR), p] USD 24594 (USD 18883-31,041), whereas the true median cost of admission for those who were getting readmitted after 30 days was [median (IQR)] USD 7699 (USD 4955-14,243). Multivariate analysis of all clinically relevant predictors showed adjusted ratio for [adjusted odds ratio (OR), 95% confidence interval (95% CI), p-value] female genders (1.288, 1.104-1.503, p = 0.001), discharge to home health care (6.155, 1.509-25.096, p = 0.01), chronic kidney disease (CKD) (1.847,1.511-2.258, p < 0.001), chronic lung disease (1.419, 1.194-1.686, p < 0.001), heart failure (1.280, 1.040-1.574, p = 0.02), pericardial disorders (1.485, 1.011-2.179, p = 0.04), fluid and electrolyte disorders (1.456,1.050-2.018, p = 0.02) in those who were getting readmitted at 30-days compared to those who were not readmitted. The median length of stay for the index hospitalization was found to be one day, whereas the median length of stay at the 30-day readmission was reported to be [Median (IQR)] 4 days (2-6 days). Major cardiac reasons for readmission were heart failure, arrhythmias, and pericardial disorders. CONCLUSION Our study aims to assess 30-day outcomes in the US population after pLAAC using a Watchman device. Our analysis showed that one in ten patients were getting readmitted. In addition, chronic kidney disease, chronic obstructive pulmonary disease, heart failure, and pericardial disorders were associated with higher readmission rates. These findings will help us assess clinical correlations and predict which patients are more at risk of readmission after a Watchman procedure.
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Affiliation(s)
- Mustafeez Ur Rahman
- Department of Internal Medicine, University of South Alabama University Hospital, Mobile, AL, United States of America.
| | - Amod Amritphale
- Department of Cardiovascular Medicine, University of South Alabama University Hospital, Mobile, AL, United States of America.
| | - Sagar Kumar
- Department of Internal Medicine, University of South Alabama University Hospital, Mobile, AL, United States of America
| | - Celeste Trice
- Department of Internal Medicine, University of South Alabama University Hospital, Mobile, AL, United States of America
| | - Ghulam Mustafa Awan
- Department of Cardiovascular Medicine, University of South Alabama University Hospital, Mobile, AL, United States of America
| | - Bassam A Omar
- Department of Cardiovascular Medicine, University of South Alabama University Hospital, Mobile, AL, United States of America
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Kumar A, Sato K, Narayanswami J, Banerjee K, Andress K, Lokhande C, Mohananey D, Anumandla AK, Khan AR, Sawant AC, Menon V, Krishnaswamy A, Tuzcu EM, Jaber WA, Mick S, Svensson LG, Kapadia SR. Current Society of Thoracic Surgeons Model Reclassifies Mortality Risk in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 11:e006664. [PMID: 30354591 DOI: 10.1161/circinterventions.118.006664] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) scores are used to screen patients for transcatheter aortic valve replacement (TAVR). The STS scores were also used to risk stratify patients in major TAVR trials. This study evaluates the reclassification of predicted risk of mortality by the currently available online STS score calculator compared with the 2008 STS risk model in patients undergoing TAVR. METHODS AND RESULTS All patients who underwent TAVR from 2006 to 2016 were included in the study. The STS scores for all included patients were calculated by applying the 2008 STS risk model and again using the current STS online calculator. Among 1209 patients who underwent TAVR, 30-day mortality was 27 (2.2%). The overall predicted risk of mortality estimated by using the current online STS risk calculator was significantly lower than the 2008 STS risk model (6.3±4.4 vs 7.3±4.9; P<0.001). A total of 235 (19%) patients were reclassified into a lower risk category per the current STS risk model. In a multivariable logistic regression analysis, patients with persistent atrial fibrillation (odds ratio, 1.4; 95% CI, 1.0-1.9; P=0.03), chronic heart failure (odds ratio, 6.0; 95% CI, 3.8-10.1; P<0.001), and New York Heart Association class IV heart failure (odds ratio, 2.4; 95% CI, 1.3-4.4; P=0.007) were more likely to be reclassified into a lower risk category per the current STS risk model. CONCLUSIONS The current STS calculation method produces significantly lower predicted risk of mortality than the 2008 calculator, more pronounced in patients with certain comorbid conditions. These results should be considered while evaluating data from prior studies of TAVR.
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Affiliation(s)
- Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Jyoti Narayanswami
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Krystof Andress
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Chetan Lokhande
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Anil Kumar Anumandla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Abdur Rahman Khan
- Division of Cardiovascular Medicine, University of Louisville, KY (A.R.K.)
| | - Abhishek C Sawant
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Vivek Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Stephanie Mick
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Lars G Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
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Mendez-Bailon M, Lorenzo-Villalba N, Muñoz-Rivas N, de Miguel-Yanes JM, De Miguel-Diez J, Comín-Colet J, Hernandez-Barrera V, Jimenez-Garcia R, Lopez-de-Andres A. Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014-2015). Cardiovasc Diabetol 2017; 16:144. [PMID: 29121921 PMCID: PMC5679322 DOI: 10.1186/s12933-017-0631-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures. Methods We analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS). Results We identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR). Conclusions T2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed. Electronic supplementary material The online version of this article (10.1186/s12933-017-0631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Mendez-Bailon
- Internal Medicine Department, Instituto de Investigación Cardiovascular, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médicine Interne et Cancerlogie, Centre Hospitalier Saint Cyr, Lyon, France
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Javier De Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Josep Comín-Colet
- Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
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