TY - JOUR
T1 - Clinical Outcomes of Transcatheter Aortic Valve Replacement (TAVR) Vs. Surgical Aortic Valve Replacement (SAVR) in Patients With Durable Left Ventricular Assist Device (LVAD)
AU - Zaidi, Syeda Humna
AU - Minhas, Abdul Mannan Khan
AU - Sagheer, Shazib
AU - ManeshGangwani, Kumar
AU - Dani, Sourbha S.
AU - Goel, Sachin S.
AU - Alam, Mahboob
AU - Sheikh, Abu Baker
AU - Hirji, Sameer
AU - Wasty, Najam
N1 - Funding Information:
Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Patients with left ventricular assist device (LVAD) often develop aortic insufficiency requiring an intervention on the aortic valve. We sought to analyze the outcomes of patients with a history of LVAD who underwent either transcatheter aortic valve replacement or surgical aortic valve replacement. The Nationwide Readmission Database was used to extract relevant patient information from January 1, 2016, to December 31, 2018. The Nationwide Readmission Database is a nationally representative sample of all-payer discharges from United States nonfederal hospitals. The primary outcome of interest was in-hospital mortality. Secondary outcomes included length of stay, clinical outcomes, costs, and 30-day all-cause readmissions. Complex samples multivariable logistic and linear regression models were used to determine the association of procedure type with outcomes. Among 148 hospitalizations with a history of LVAD, 87 underwent transcatheter aortic valve replacement (TAVR), and 61 underwent surgical aortic valve replacement (SAVR). The inpatient mortality in SAVR group was numerically higher compared to the TAVR cohort, however, it did not reach statistical significance. The use of invasive mechanical ventilation, and rates of cardiogenic shock, bleeding, and vascular complications were higher in the SAVR cohort compared to the TAVR cohort. The mean length of stay and costs were higher in the SAVR cohort compared to the TAVR cohort. The 30-day all-cause readmission rate was numerically higher in the SAVR group but not statistically significant. TAVR in patients with LVAD may be a viable treatment option for patients with AI with potential for better inpatient mortality and inpatient outcomes compared to patients who undergo SAVR in appropriately selected patients.
AB - Patients with left ventricular assist device (LVAD) often develop aortic insufficiency requiring an intervention on the aortic valve. We sought to analyze the outcomes of patients with a history of LVAD who underwent either transcatheter aortic valve replacement or surgical aortic valve replacement. The Nationwide Readmission Database was used to extract relevant patient information from January 1, 2016, to December 31, 2018. The Nationwide Readmission Database is a nationally representative sample of all-payer discharges from United States nonfederal hospitals. The primary outcome of interest was in-hospital mortality. Secondary outcomes included length of stay, clinical outcomes, costs, and 30-day all-cause readmissions. Complex samples multivariable logistic and linear regression models were used to determine the association of procedure type with outcomes. Among 148 hospitalizations with a history of LVAD, 87 underwent transcatheter aortic valve replacement (TAVR), and 61 underwent surgical aortic valve replacement (SAVR). The inpatient mortality in SAVR group was numerically higher compared to the TAVR cohort, however, it did not reach statistical significance. The use of invasive mechanical ventilation, and rates of cardiogenic shock, bleeding, and vascular complications were higher in the SAVR cohort compared to the TAVR cohort. The mean length of stay and costs were higher in the SAVR cohort compared to the TAVR cohort. The 30-day all-cause readmission rate was numerically higher in the SAVR group but not statistically significant. TAVR in patients with LVAD may be a viable treatment option for patients with AI with potential for better inpatient mortality and inpatient outcomes compared to patients who undergo SAVR in appropriately selected patients.
KW - Aortic Valve
KW - Aortic Valve Stenosis
KW - Heart Valve Prosthesis Implantation
KW - Heart-Assist Devices
KW - Humans
KW - Length of Stay
KW - Risk Factors
KW - Time Factors
KW - Transcatheter Aortic Valve Replacement
KW - Treatment Outcome
KW - United States
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UR - http://www.scopus.com/inward/citedby.url?scp=85136254408&partnerID=8YFLogxK
U2 - 10.1016/j.cpcardiol.2022.101313
DO - 10.1016/j.cpcardiol.2022.101313
M3 - Review article
C2 - 35817155
AN - SCOPUS:85136254408
SN - 0146-2806
VL - 47
SP - 101313
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
IS - 10
M1 - 101313
ER -