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Gregory AJ, Kent WDT, Adams C, Arora RC. Closing the care gap: combining enhanced recovery with minimally invasive valve surgery. Curr Opin Cardiol 2024; 39:380-387. [PMID: 38606679 DOI: 10.1097/hco.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Patients with advanced age and frailty require interventions for structural heart disease at an increasing rate. These patients typically experience higher rates of postoperative morbidity, mortality and prolonged hospital length of stay, loss of independence as well as associated increased costs to the healthcare system. Therefore, it is becoming critically important to raise awareness and develop strategies to improve clinical outcomes in the contemporary, high-risk patient population undergoing cardiacprocedures. RECENT FINDINGS Percutaneous options for structural heart disease have dramatically improved the therapeutic options for some older, frail, high-risk patients; however, others may still require cardiac surgery. Minimally invasive techniques can reduce some of the physiologic burden experienced by patients undergoing surgery and improve recovery. Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) is a comprehensive, interdisciplinary, evidence-based approach to perioperative care. It has been shown to improve recovery and patient satisfaction while reducing complications and length of stay. SUMMARY Combining minimally invasive cardiac surgery with enhanced recovery protocols may result in improved patient outcomes for a patient population at high risk of morbidity and mortality following cardiac surgery.
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Affiliation(s)
- Alexander J Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - William D T Kent
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Corey Adams
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Rakesh C Arora
- Harrington Heart and Vascular Institute - University Hospitals, Cleveland, Ohio, USA
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2
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Cohen I, Beigel R, Guetta V, Segev A, Fefer P, Matetzky S, Mazin I, Berger M, Perlman S, Barbash IM, Ziv-Baran T. Cardiology department versus intensive care unit admission after successful uncomplicated transcatheter aortic valve replacement (TAVR). Am J Med Sci 2024:S0002-9629(24)01274-6. [PMID: 38876433 DOI: 10.1016/j.amjms.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/11/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Most patients after transcatheter aortic valve replacement (TAVR) are admitted directly to the cardiac intensive care unit (CICU) despite low complication rates. Reducing unnecessary CICU hospitalization reduces healthcare costs. This study aimed to compare the outcomes between patients admitted directly to the cardiology department (CD) and those admitted to CICU based on prespecified protocols. METHODS Historical cohort study of all patients who underwent TAVR and were admitted directly to the CD according to a prespecified protocol (uncomplicated procedure, hemodynamically stable, without new conduction abnormalities) in 2017-2018, and the same number of patients meeting the same criteria who were admitted to the CICU in 2015-2016 before direct CD admission was initiated. Pacemaker implantation during the procedure was not considered a new conduction abnormality. In-hospital outcomes and 30-day post-discharge outcomes were compared. RESULTS Overall, 260 patients (130 CICU + 130 CD) were included in the study. There was no in-hospital mortality in either group, and the post-procedure length of stay was shorter for patients admitted to CD (median and IQR: 2, 2-4 vs. 4, 3-5 days, p<0.001). There was no significant difference in 30-day emergency department visits between groups (CICU:13.9% vs. CD:16.2%, p=0.602), rehospitalization rate (9.3%) was the same in both groups, and one patient from the CICU group died. Similar results were observed in multivariable analysis and after matching. CONCLUSION Direct admission to the CD after TAVR, according to the proposed criteria, may be considered as a safe and less expensive alternative for stable patients after an uncomplicated TAVR procedure.
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Affiliation(s)
- Ilanit Cohen
- School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Beigel
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Matetzky
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Mazin
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Berger
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saritte Perlman
- School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Israel Moshe Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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3
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Li R, Prastein DJ, Choi BG. Socioeconomic disparity in transcatheter and surgical aortic valve replacement: a population study of National Inpatient Sample from 2015 to 2020. Sci Rep 2024; 14:11762. [PMID: 38783030 PMCID: PMC11116551 DOI: 10.1038/s41598-024-62797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS). This study conducted a population-based analysis to assess the influence of SES on valve replacement outcomes. Patients with AS undergoing TAVR or SAVR were identified in National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients living in neighborhoods of income at the lowest and highest quartiles. Of 613,785 AS patients, 9.77% underwent TAVR and 10.13% had SAVR. These rates decline with lower neighborhood income levels, with TAVR/SAVR ratio also declining in lower-income areas. Excluding concomitant procedures, 58,064 patients received isolated TAVR (12,355 low-income and 15,212 high-income) and 43,694 underwent isolated SAVR (10,029 low-income and 10,811 high-income). Low-income patients, in both TAVR and SAVR, were younger but had more comorbid burden. For isolated TAVR, outcomes were similar across income groups. However, for isolated SAVR, low-income patients experienced higher in-hospital mortality (aOR = 1.44, p < 0.01), pulmonary (aOR = 1.13, p = 0.01), and renal complications (aOR = 1.14, p < 0.01). They also had more transfers, longer waits for operations, and extended hospital stays. Lower-income communities had reduced access to TAVR and SAVR, with TAVR accessibility being particularly limited. When given access to TAVR, patients from lower-income neighborhoods had mostly comparable outcomes. However, patients from low-income communities faced worse outcomes in SAVR, possibly due to delays in treatment. Ensuring equitable specialized healthcare resources including expanding TAVR access in economically disadvantaged communities is crucial.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
| | - Deyanira J Prastein
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Brian G Choi
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
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4
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Brown C, Ryan MP, Chikermane SG, Kelley MA, Walker TM, Stinis CT. Incremental costs of new permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00071-X. [PMID: 38429171 DOI: 10.1016/j.carrev.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
| | - Michael P Ryan
- MPR Consulting, Cincinnati, OH, United States of America
| | | | | | - Tara M Walker
- Edwards Lifesciences, Irvine, CA, United States of America
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5
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Fath AR, Aglan A, Khurana A, Abuasbeh J, Eldaly AS, Mantha Y, Abraham B, Olagunju A, Prasad A. Transcatheter Aortic Valve Replacement: Variations in Use, Charges, and Geography in the United States. Am J Cardiol 2023; 205:363-368. [PMID: 37647820 DOI: 10.1016/j.amjcard.2023.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023]
Abstract
The use of transcatheter aortic valve replacement (TAVR) in the United States has been increasing but with variability. We used a 100% sample of Medicare beneficiaries (MBs), from the Centers for Medicare and Medicaid Services database, who underwent TAVR by cardiologists between 2015 and 2019. We stratified data by geographic region, rural/urban areas, and provider's gender. We examined the average number of TAVRs performed per 100,000 MBs, the average number of TAVRs performed per individual cardiologist, and the average submitted charge (ASC) per procedure. The number of TAVR per 100,000 MBs was significantly variable among regions in all years (all P≤0.028), except in 2015 (P=0.103), with the highest rates being in the Northeast and the lowest being in the West. The number of TAVRs per cardiologist was significantly different among regions only in 2019 (P=0.04), with the Northeast showing the highest numbers and the South showing the lowest. The ASC was also significantly variable among regions in all years (all P≤0.01). The highest ASC was in the Midwest for all years, whereas the lowest was in the West in 2015 to 2016 and in the South in 2017 to 2019. In all years, the number of TAVRs per cardiologist was higher in urban areas than in rural areas (all P<0.05); however, rural cardiologists had higher ASCs (all P<0.05). The number of TAVR procedures per cardiologist was not significantly different between male and female cardiologists (all P>0.1). Female cardiologists had a significantly higher ASC only in 2015 (P=0.034). In conclusion, there are variations in TAVR use and charges for MBs according to geographic, urban, and rural regions and the performing cardiologist's gender.
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Affiliation(s)
- Ayman R Fath
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas
| | - Amro Aglan
- Department of Internal Medicine, Beth Israel Lahey Health, Boston, Massachusetts
| | - Aditya Khurana
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jumanah Abuasbeh
- Department of Public Health, University of Arizona, Phoenix, Arizona
| | | | - Yogamaya Mantha
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | | | - Anand Prasad
- Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas.
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6
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Kermanshahchi J, Thind B, Davoodpour G, Hirsch M, Chen J, Reddy AJ, Chan E, Yu Z, Javidi D. A Review of the Cost Effectiveness of Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR). Cureus 2023; 15:e46535. [PMID: 37927639 PMCID: PMC10625447 DOI: 10.7759/cureus.46535] [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: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
The cost of transcatheter aortic valve replacement (TAVR) has been studied in the context of high-risk or specific comorbidity populations; this paper provides a comprehensive overview of broader patient populations' outcomes and costs with TAVR in comparison to surgical aortic valve replacement (SAVR). In the past, SAVR had been the more cost-effective option than TAVR, but in recent years, TAVR has been becoming more cost-effective.Though the cost of TAVR can vary due to several factors the major focus of this review will focus on the surgical technique, medicare reimbursements, insertion point, and varying risk populations. In conclusion, the price of TAVR is declining as more cost-efficient valves arrive on the market. Climbing healthcare costs play a significant role in clinical decisions when deciding on which procedures are most cost-effective for the patient and healthcare system. The declining price of TAVR could lead to the preference of TAVR over SAVR for both low-risk and high-risk aortic stenosis patients.
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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
| | - Evan Chan
- Medicine, California Northstate University, Elk Grove, USA
| | - Zeyu Yu
- Medicine, California Health Science University, Clovis, USA
| | - Daryoush Javidi
- Medical Education, California University of Science and Medicine, Colton, USA
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7
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Reddy KP, Eberly LA, Halaby R, Julien H, Khatana SAM, Dayoub EJ, Coylewright M, Alkhouli M, Fiorilli PN, Kobayashi TJ, Goldberg DM, Santangeli P, Herrmann HC, Giri J, Groeneveld PW, Fanaroff AC, Nathan AS. Racial, Ethnic, and Socioeconomic Inequities in Access to Left Atrial Appendage Occlusion. J Am Heart Assoc 2023; 12:e028032. [PMID: 36802837 PMCID: PMC10111439 DOI: 10.1161/jaha.122.028032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Inequitable access to high-technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code-level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs. Methods and Results We conducted cross-sectional analyses of Medicare fee-for-service claims for beneficiaries aged 66 years or older between 2016 and 2019. We identified hospitals establishing LAAO programs during the study period. We used generalized linear mixed models to measure the association between zip code-level racial, ethnic, and socioeconomic composition and age-adjusted rates of LAAO in the most populous 25 metropolitan areas with LAAO sites. During the study period, 507 candidate hospitals started LAAO programs, and 745 candidate hospitals did not. Most new LAAO programs opened in metropolitan areas (97.4%). Compared with non-LAAO centers, LAAO centers treated patients with higher median household incomes (difference of $913 [95% CI, $197-$1629], P=0.01). Zip code-level rates of LAAO procedures per 100 000 Medicare beneficiaries in large metropolitan areas were 0.34% (95% CI, 0.33%-0.35%) lower for each $1000 zip code-level decrease in median household income. After adjustment for socioeconomic markers, age, and clinical comorbidities, LAAO rates were lower in zip codes with higher proportions of Black or Hispanic patients. Conclusions Growth in LAAO programs in the United States had been concentrated in metropolitan areas. LAAO centers treated wealthier patient populations in hospitals without LAAO programs. Within major metropolitan areas with LAAO programs, zip codes with higher proportions of Black and Hispanic patients and more patients experiencing socioeconomic disadvantage had lower age-adjusted rates of LAAO. Thus, geographic proximity alone may not ensure equitable access to LAAO. Unequal access to LAAO may reflect disparities in referral patterns, rates of diagnosis, and preferences for using novel therapies experienced by racial and ethnic minority groups and patients experiencing socioeconomic disadvantage.
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Affiliation(s)
- Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA
| | - Lauren A Eberly
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Rim Halaby
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Howard Julien
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Sameed Ahmed M Khatana
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Elias J Dayoub
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | | | | | - Paul N Fiorilli
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Taisei J Kobayashi
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | | | - Pasquale Santangeli
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Howard C Herrmann
- Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA.,Division of General Internal Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
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8
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Abstract
This Viewpoint discusses the structural barriers to care that exist for patients of racial and ethnic minoritized and socioeconomically disadvantaged groups and proposes solutions to address the inequities in health care delivery.
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Affiliation(s)
- Kriyana Pasham Reddy
- Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren Anne Eberly
- Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Ashwin Senthil Nathan
- Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
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9
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Nathan AS, Fiorilli PN, Giri J. Trial End Points and Measures of Quality: Similar but Different. Circ Cardiovasc Interv 2022; 15:e012649. [PMID: 36538578 DOI: 10.1161/circinterventions.122.012649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ashwin S Nathan
- Cardiovascular Medicine Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA (A.S.N., P.N.F., J.G.).,Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA (A.S.N., J.G.).,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (A.S.N., P.N.F., J.G.)
| | - Paul N Fiorilli
- Cardiovascular Medicine Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA (A.S.N., P.N.F., J.G.).,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (A.S.N., P.N.F., J.G.)
| | - Jay Giri
- Cardiovascular Medicine Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA (A.S.N., P.N.F., J.G.).,Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA (A.S.N., J.G.).,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (A.S.N., P.N.F., J.G.)
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10
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Dall'Ara G, Grotti S, Guerrieri G, Compagnone M, Spartà D, Galvani M, Tarantino F. Balloon aortic valvuloplasty: current status and future prospects. Expert Rev Cardiovasc Ther 2022; 20:389-402. [PMID: 35514027 DOI: 10.1080/14779072.2022.2074837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Balloon aortic valvuloplasty (BAV) improves hemodynamic and clinical status of patients with severe aortic stenosis (AS) for a limited period of 6-12 months. However, there is a high number of procedures performed worldwide and an upward trend over the last decades. AREAS COVERED Epidemiology of AS and the advent of transcatheter aortic valve implantation (TAVI) contribute to the extensive referral of patients. The expansion of recommendations for TAVI has occasionally led to financial reimbursement-related problems that do not exist for BAV. BAV is indicated as a bridge to valve replacement, to decision in complex cases, and to extracardiac surgery. BAV may play a role in preparing for TAVI and optimizing procedural results. The minimalist approach and reduced complication rate make it applicable in fragile patients. EXPERT OPINION In the near future, BAV will continue to be a useful asset in managing patients with AS given the multiple indications, broad applicability, safety profile, low cost, and repeatability. Specific studies are necessary to explore technical solutions, stronger indications, the finest technique, and to standardize the procedural result. Pending the development of potential competitive devices, the role that BAV plays will remain closely intertwined with the one played by TAVI.
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Affiliation(s)
| | - Simone Grotti
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Daniela Spartà
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Marcello Galvani
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,Cardiovascular Research Unit, Myriam Zito Sacco Heart Foundation, Forlì, Italy
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11
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Giri J, Fiorilli PN. Did the COVID-19 Pandemic Just Turn TAVR Into an Outpatient Procedure? JACC Cardiovasc Interv 2022; 15:599-602. [PMID: 35331451 PMCID: PMC10042628 DOI: 10.1016/j.jcin.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 12/21/2022]
Affiliation(s)
- Jay Giri
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Paul N Fiorilli
- Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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