Abstract
Objectives: The purpose of this study was to assess the temporal trends of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS), and to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) in this population. Background: Randomized trials comparing TAVR to SAVR in AS with bicuspid valve are lacking. Methods: The study queried the National Inpatient Sample database (years 2012 to 2016) to identify hospitalizations for bicuspid AS who underwent isolated aortic valve replacement. A propensity-matched analysis was used to compare outcomes of hospitalizations for TAVR versus SAVR for bicuspid AS and TAVR for bicuspid AS versus tricuspid AS. Results: The analysis included 31,895 hospitalizations with bicuspid AS, of whom 1,055 (3.3%) underwent TAVR. TAVR was increasingly utilized during the study period for bicuspid AS (ptrend = 0.002). After matching, TAVR and SAVR had similar in-hospital mortality (3.1% vs. 3.1%; odds ratio: 1.00; 95% confidence interval: 0.60 to 1.67). There was no difference between TAVR and SAVR in the rates of cardiac arrest, cardiogenic shock, acute kidney injury, hemopericardium, cardiac tamponade, or acute stroke. TAVR was associated with lower rates of acute myocardial infarction, post-operative bleeding, vascular complications, and discharge to nursing facility as well as a shorter length of hospital stay. On the contrary, TAVR was associated with a higher incidence of complete heart block and permanent pacemaker insertion. TAVR for bicuspid AS was associated with similar in-hospital mortality compared with tricuspid AS. Conclusions: This nationwide analysis showed similar in-hospital mortality for TAVR and SAVR in patients with bicuspid AS. TAVR for bicuspid AS was also associated with similar in-hospital mortality compared with tricuspid AS. Further studies are needed to evaluate long-term outcomes of TAVR for bicuspid AS.
| Original language | English |
|---|---|
| Pages (from-to) | 1811-1822 |
| Number of pages | 12 |
| Journal | JACC: Cardiovascular Interventions |
| Volume | 12 |
| Issue number | 18 |
| DOIs | |
| State | Published - Sep 23 2019 |
Bibliographical note
Publisher Copyright:© 2019 American College of Cardiology Foundation
Funding
This analysis was derived from the National Inpatient Sample (NIS) database, which is part of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality. The NIS database is the largest inpatient care database in the United States (10) , which is derived from the billing data submitted by hospitals to statewide data organizations across the United States. The NIS covers all patients, including those covered by Medicare, Medicaid, private insurance, and the uninsured. For Medicare, the NIS database includes Medicare Advantage patients, a population that is often missing from the Medicare claims data but comprises 30% of Medicare beneficiaries (11) . The NIS database contains more than 100 clinical data elements from ∼7 million unweighted hospitalizations annually, representing 20% of hospital admissions in the United States. Data from the NIS database have been previously used to describe trends and inpatients outcomes for various disease (12–15) . The NIS reports data using the International Classification of Diseases-9th Revision (ICD-9) to September 2015, while data from October 2015 to 2016 are reported using International Classification of Diseases-10th Revision (ICD-10) codes. This study was exempt from Institutional Review Board evaluation, as it contains de-identified data that are publicly available.
| Funders | Funder number |
|---|---|
| Agency for Healthcare Research and Quality |
Keywords
- bicuspid aortic valve
- surgical aortic valve replacement
- transcatheter aortic valve replacement
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine