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Akintoye E, Ando T, Sandio A, Adegbala O, Salih M, Zubairu J, Oseni A, Sistla P, Alqasrawi M, Egbe A, Mentias A, Afonso L, Briasoulis A, Panaich S, Desai MY. Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 126:73-81. [PMID: 32336533 DOI: 10.1016/j.amjcard.2020.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
Abstract
Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.
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Affiliation(s)
- Emmanuel Akintoye
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
| | - Tomo Ando
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Aubin Sandio
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Oluwole Adegbala
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohamed Salih
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Josiah Zubairu
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Abdullahi Oseni
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Phanicharan Sistla
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Musab Alqasrawi
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Alexander Egbe
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Luis Afonso
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Milind Y Desai
- Center for Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
Biliary anatomic pathologies are rare disease occurrences that can result from a number of causes, most commonly iatrogenic, infectious and malignant aetiologies. Communications between the biliary and bronchial systems are even rarer and few cases have been documented in the literature. The present study describes a case of a 70-year-old man who underwent a pancreaticoduodenectomy (Whipple Procedure) as a curative procedure for an early stage neuroendocrine tumour. He presented nearly a decade after surgery with a communication between the biliary and bronchial tree initially manifesting as bilioptysis. His underlying medical conditions and poor clinical picture made treatment options limited. Therefore, he was treated conservatively with percutaneous biliary balloon dilation of the anastomotic stricture followed by temporary percutaneous internal/external drain and made a full recovery.
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Affiliation(s)
| | - Josiah Zubairu
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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