The Midterm Impact of Transcatheter Aortic Valve Replacement on Surgical Aortic Valve Replacement in Michigan

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• 作者：Himanshu J. Patel ; MD^a ; ^{hjpatel@med.umich.edu" class="auth_mail" title="E-mail the corresponding author} ; Morley A. Herbert ; PhD^b ; Gaetano Paone ; MD ; MHSA^c ; John C. Heiser ; MD^d ; Francis L. Shannon ; MD^e ; Patricia F. Theurer ; RN ; BSN^f ; Gail F. Bell ; RN ; MSN^f ; Richard L. Prager ; MD^a ; for the Michigan Society of Thoracic ; Cardiovascular Surgeons
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：102
• 期：3
• 页码：728-734
• 全文大小：633 K

文摘

We characterized the midterm impact of transcatheter aortic valve replacement (TAVR) on surgical aortic valve replacement (SAVR) volume, patient profiles, and outcomes in Michigan.

absSec_2">Methods

abspara0015">We analyzed data obtained after SAVR (n = 15,288) and TAVR (n = 1,783) using the Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative from 2006 to 2015. During this period, 17 of 33 hospitals developed TAVR programs.

absSec_3">Results

abspara0020">Annual SAVR volume increased by 38.1% at TAVR hospitals and by 20.4% at non-TAVR hospitals, (p trend < 0.001). In TAVR hospitals, the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) decreased before (4.7% ± 5.1%) and after (3.5% ± 3.6%) initiation of TAVR (p < 0.001). Rates of 30-day mortality (pre-TAVR, 3.9% vs post-TAVR, 2.7%; p < 0.001) and renal failure (pre-TAVR, 5.2% vs post-TAVR, 3.3%; p < 0.001) but not stroke (pre-TAVR, 1.9% vs post-TAVR, 1.7%; p = 0.47) were lower after TAVR implementation. Length of stay decreased from 9.0 to 8.5 days (p < 0.001). When analyzing high-risk patients undergoing SAVR (ie, PROM >8%), neither mortality, stroke, nor renal failure was different (all p > 0.15). Despite a reduction in the STS-PROM, non-TAVR hospitals did not display changes in mortality, stroke, or renal failure for either the entire or the high-risk SAVR cohorts after initiation of TAVR in Michigan.

absSec_4">Conclusions

abspara0025">TAVR implementation in Michigan has dramatically increased overall SAVR volume. This phenomenon has occurred with a concomitant decrease in preoperative risk profile and has improved early SAVR outcomes, particularly at TAVR hospitals, but surprisingly not in patients considered at high preoperative risk. As TAVR use increases, these issues may be further clarified and elucidated.