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In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians

BACKGROUND: Octogenarians have low physiologic reserve and may benefit more from transcatheter aortic valve replacement (TAVR) than surgical aortic valve replacement (SAVR). METHODS AND RESULTS: This retrospective cohort study based on the National Inpatient Sample included octogenarians who underwe...

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Autores principales: Sheng, Siyuan P., Strassle, Paula D., Arora, Sameer, Kolte, Dhaval, Ramm, Cassandra J., Sitammagari, Kranthi, Guha, Avirup, Paladugu, Madhu B., Cavender, Matthew A., Vavalle, John P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497334/
https://www.ncbi.nlm.nih.gov/pubmed/30663494
http://dx.doi.org/10.1161/JAHA.118.011206
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author Sheng, Siyuan P.
Strassle, Paula D.
Arora, Sameer
Kolte, Dhaval
Ramm, Cassandra J.
Sitammagari, Kranthi
Guha, Avirup
Paladugu, Madhu B.
Cavender, Matthew A.
Vavalle, John P.
author_facet Sheng, Siyuan P.
Strassle, Paula D.
Arora, Sameer
Kolte, Dhaval
Ramm, Cassandra J.
Sitammagari, Kranthi
Guha, Avirup
Paladugu, Madhu B.
Cavender, Matthew A.
Vavalle, John P.
author_sort Sheng, Siyuan P.
collection PubMed
description BACKGROUND: Octogenarians have low physiologic reserve and may benefit more from transcatheter aortic valve replacement (TAVR) than surgical aortic valve replacement (SAVR). METHODS AND RESULTS: This retrospective cohort study based on the National Inpatient Sample included octogenarians who underwent TAVR or SAVR from 2012 to 2015. Crude and standardized‐morbidity‐ratio‐weighted regression models were used to compare in‐hospital outcomes. Among 19 145 TAVR and 9815 SAVR hospitalizations, TAVR patients had higher Charlson Comorbidity Index (CCI) scores (2.0 versus 0.8, P<0.0001) than SAVR patients. Before weighting, TAVR was associated with significantly shorter length of stay, more home discharges, and lower incidences of acute kidney injury, bleeding, and cardiogenic shock. Associations were consistent across Charlson Comorbidity Index, except for TAVR being associated with greater length of stay reductions among patients with Charlson Comorbidity Index ≥2, compared with Charlson Comorbidity Index <2 (change in estimate −3.56 versus −2.61 days, P=0.004). After weighting, TAVR patients had significantly shorter length of stay (change in estimate −3.29 days, 95% CI −3.82, −2.75) and lower odds of transfer to skilled nursing facility (odds ratio 0.34, 95% CI 0.29, 0.41), acute kidney injury (odds ratio 0.55, 95% CI 0.45, 0.68), bleeding (odds ratio 0.44, 95% CI 0.37, 0.53), and cardiogenic shock (odds ratio 0.55, 95% CI 0.33, 0.92), compared with SAVR patients. Odds of permanent pacemaker implantation, transient ischemic attack/stroke, vascular complications, and in‐hospital mortality were not significantly different. CONCLUSIONS: TAVR may be preferred over SAVR in high‐risk octogenarians because of shorter length of stay, better discharge disposition, and less acute kidney injury, and bleeding. All octogenarians may benefit more from TAVR, irrespective of comorbidity burden, but additional research is needed to confirm our findings.
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spelling pubmed-64973342019-05-07 In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians Sheng, Siyuan P. Strassle, Paula D. Arora, Sameer Kolte, Dhaval Ramm, Cassandra J. Sitammagari, Kranthi Guha, Avirup Paladugu, Madhu B. Cavender, Matthew A. Vavalle, John P. J Am Heart Assoc Original Research BACKGROUND: Octogenarians have low physiologic reserve and may benefit more from transcatheter aortic valve replacement (TAVR) than surgical aortic valve replacement (SAVR). METHODS AND RESULTS: This retrospective cohort study based on the National Inpatient Sample included octogenarians who underwent TAVR or SAVR from 2012 to 2015. Crude and standardized‐morbidity‐ratio‐weighted regression models were used to compare in‐hospital outcomes. Among 19 145 TAVR and 9815 SAVR hospitalizations, TAVR patients had higher Charlson Comorbidity Index (CCI) scores (2.0 versus 0.8, P<0.0001) than SAVR patients. Before weighting, TAVR was associated with significantly shorter length of stay, more home discharges, and lower incidences of acute kidney injury, bleeding, and cardiogenic shock. Associations were consistent across Charlson Comorbidity Index, except for TAVR being associated with greater length of stay reductions among patients with Charlson Comorbidity Index ≥2, compared with Charlson Comorbidity Index <2 (change in estimate −3.56 versus −2.61 days, P=0.004). After weighting, TAVR patients had significantly shorter length of stay (change in estimate −3.29 days, 95% CI −3.82, −2.75) and lower odds of transfer to skilled nursing facility (odds ratio 0.34, 95% CI 0.29, 0.41), acute kidney injury (odds ratio 0.55, 95% CI 0.45, 0.68), bleeding (odds ratio 0.44, 95% CI 0.37, 0.53), and cardiogenic shock (odds ratio 0.55, 95% CI 0.33, 0.92), compared with SAVR patients. Odds of permanent pacemaker implantation, transient ischemic attack/stroke, vascular complications, and in‐hospital mortality were not significantly different. CONCLUSIONS: TAVR may be preferred over SAVR in high‐risk octogenarians because of shorter length of stay, better discharge disposition, and less acute kidney injury, and bleeding. All octogenarians may benefit more from TAVR, irrespective of comorbidity burden, but additional research is needed to confirm our findings. John Wiley and Sons Inc. 2019-01-19 /pmc/articles/PMC6497334/ /pubmed/30663494 http://dx.doi.org/10.1161/JAHA.118.011206 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Sheng, Siyuan P.
Strassle, Paula D.
Arora, Sameer
Kolte, Dhaval
Ramm, Cassandra J.
Sitammagari, Kranthi
Guha, Avirup
Paladugu, Madhu B.
Cavender, Matthew A.
Vavalle, John P.
In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
title In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
title_full In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
title_fullStr In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
title_full_unstemmed In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
title_short In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
title_sort in‐hospital outcomes after transcatheter versus surgical aortic valve replacement in octogenarians
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497334/
https://www.ncbi.nlm.nih.gov/pubmed/30663494
http://dx.doi.org/10.1161/JAHA.118.011206
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