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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2018 Feb 08

DOI: 10.23736/S0021-9509.18.10321-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Early post-approval experience with transcatheter aortic valve replacement in the United States

Jennifer M. BURG 1, Nora F. FINO 2, Frederick A. TIBAYAN 1, Victor RODRIGUEZ 1, Jaishankar RAMAN 1, Firas ZAHR 3, Howard K. SONG 1

1 Divisions of Cardiothoracic Surgery, Oregon Health & Science University, Portland, Oregon; 2 Biostatistics & Design Program, Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, Oregon; 3 Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon


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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TAVR versus surgical aortic valve repair (SAVR) in the real-world setting since US TAVR approval in 2012.
METHODS: The Nationwide Inpatient Sample (NIS) dataset was analyzed by quarter (Jun 2012- Dec 2014). Patients (>65yo) undergoing TAVR or SAVR were identified and risk stratified based on APR-DRG Mortality risk score. Outcomes were in-hospital mortality, length of stay (LOS), discharge location, and hospitalization cost.
RESULTS: TAVR cases per quarter increased from 1,900 to 5,445 over the study period. TAVR patients were older and had more comorbidities (p<0.001). TAVR patients had longer LOS (8 vs 7 days; p<0.001), were less likely to discharge to home (67% vs 73%; p<0.001), had higher inpatient mortality (5.5% vs 0.69%; p<0.001) and overall hospital cost ($227,985 vs $148,019; p<0.001) than SAVR patients. On multivariate analysis TAVR was associated with increased cost (β = 0.42; p<0.001) and increased mortality (OR 5.228, CI 3.508-7.791; p<0.001) but not associated with increased LOS (β = 0.297; p=0.078) or discharge to facility (OR 1.004, CI 0.833-1.213; p=0.960). In the last two quarters of 2014 there was no difference between TAVR and SAVR LOS, however TAVR cost did not decrease over the study period.
CONCLUSIONS: TAVR patients represented a sicker population, however LOS and discharge location outcomes were equivalent to SAVR. TAVR remained significantly more expensive across all risk groups and cost did not fall over the course of the study.


KEY WORDS: Aortic valve - TAVR - Cost - Endovascular

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Publication History

Article first published online: February 08, 2018
Manuscript accepted: January 30, 2018
Manuscript received: November 17, 2017

Cite this article as

Burg JM, Fino NF, Tibayan FA, Rodriguez V, Raman J, Zahr F, et al. Early post-approval experience with transcatheter aortic valve replacement in the United States. J Cardiovasc Surg 2018 Feb 08. DOI: 10.23736/S0021-9509.18.10321-1

Corresponding author e-mail

songh@ohsu.edu