Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States
Background The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated. Meth...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031461 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850269954698379264 |
|---|---|
| author | James E. Harvey Samir R. Kapadia David J. Cohen Ankur Kalra William Irish Candace Gunnarsson Michael Ryan Soumya G. Chikermane Christin Thompson Rishi Puri |
| author_facet | James E. Harvey Samir R. Kapadia David J. Cohen Ankur Kalra William Irish Candace Gunnarsson Michael Ryan Soumya G. Chikermane Christin Thompson Rishi Puri |
| author_sort | James E. Harvey |
| collection | DOAJ |
| description | Background The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated. Methods and Results We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries, aged ≥65 years, treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study end point was the occurrence of a major complication (composite outcome) during index and up to 30 days after. Multivariable logistic regression was used to assess odds of complications for TAVR and SAVR, individually over time, and for TAVR versus SAVR, over time. The cohort included 211 212 patients (mean±SD age, 78.6±7.3 years; 45.0% women). Complication rates during index following elective isolated aortic valve replacement decreased from 49% in 2012 to 22% in 2019. These reductions were more pronounced for TAVR (41% to >19%, Δ=22%) than SAVR (51% to >47%, Δ=4%). After risk adjustment, the risk of any complication with TAVR was 47% (P<0.0001) lower compared with SAVR in 2012, and 78% (P<0.0001) lower in 2019. TAVR was independently associated with reduced odds of complications each year compared with 2012, with the magnitude of benefit increasing over time (2013 versus 2012: odds ratio [OR], 0.89 [95% CI, 0.81–0.97]; 2019 versus 2012: OR, 0.35 [95% CI, 0.33–0.38]). These findings are consistent for complications up to 30 days from index. Conclusions Between 2012 and 2019, the risk of complications after aortic valve replacement among Medicare beneficiaries decreased significantly, with larger absolute and relative changes among patients treated with TAVR than SAVR. |
| format | Article |
| id | doaj-art-9acd5c883798498887d64bfa33b97ba2 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-9acd5c883798498887d64bfa33b97ba22025-08-20T01:52:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-09-01131710.1161/JAHA.123.031461Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United StatesJames E. Harvey0Samir R. Kapadia1David J. Cohen2Ankur Kalra3William Irish4Candace Gunnarsson5Michael Ryan6Soumya G. Chikermane7Christin Thompson8Rishi Puri9WellSpan Health System York PA USADepartment of Cardiovascular Medicine Cleveland Clinic Cleveland OH USACardiovascular Research Foundation and St Francis Hospital Roslyn NY USAFranciscan Health Lafayette IN USABrody School of Medicine Greenville NC USAGunnarsson Consulting Jupiter FL USAMPR Consulting Cincinnati OH USAEdwards Lifesciences Irvine CA USAEdwards Lifesciences Irvine CA USADepartment of Cardiovascular Medicine Cleveland Clinic Cleveland OH USABackground The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated. Methods and Results We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries, aged ≥65 years, treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study end point was the occurrence of a major complication (composite outcome) during index and up to 30 days after. Multivariable logistic regression was used to assess odds of complications for TAVR and SAVR, individually over time, and for TAVR versus SAVR, over time. The cohort included 211 212 patients (mean±SD age, 78.6±7.3 years; 45.0% women). Complication rates during index following elective isolated aortic valve replacement decreased from 49% in 2012 to 22% in 2019. These reductions were more pronounced for TAVR (41% to >19%, Δ=22%) than SAVR (51% to >47%, Δ=4%). After risk adjustment, the risk of any complication with TAVR was 47% (P<0.0001) lower compared with SAVR in 2012, and 78% (P<0.0001) lower in 2019. TAVR was independently associated with reduced odds of complications each year compared with 2012, with the magnitude of benefit increasing over time (2013 versus 2012: odds ratio [OR], 0.89 [95% CI, 0.81–0.97]; 2019 versus 2012: OR, 0.35 [95% CI, 0.33–0.38]). These findings are consistent for complications up to 30 days from index. Conclusions Between 2012 and 2019, the risk of complications after aortic valve replacement among Medicare beneficiaries decreased significantly, with larger absolute and relative changes among patients treated with TAVR than SAVR.https://www.ahajournals.org/doi/10.1161/JAHA.123.031461aortic stenosiscomplicationssurgical aortic valve replacementtranscatheter aortic valve replacementtrends |
| spellingShingle | James E. Harvey Samir R. Kapadia David J. Cohen Ankur Kalra William Irish Candace Gunnarsson Michael Ryan Soumya G. Chikermane Christin Thompson Rishi Puri Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis complications surgical aortic valve replacement transcatheter aortic valve replacement trends |
| title | Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States |
| title_full | Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States |
| title_fullStr | Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States |
| title_full_unstemmed | Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States |
| title_short | Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States |
| title_sort | trends in complications among patients undergoing aortic valve replacement in the united states |
| topic | aortic stenosis complications surgical aortic valve replacement transcatheter aortic valve replacement trends |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031461 |
| work_keys_str_mv | AT jameseharvey trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT samirrkapadia trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT davidjcohen trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT ankurkalra trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT williamirish trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT candacegunnarsson trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT michaelryan trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT soumyagchikermane trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT christinthompson trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates AT rishipuri trendsincomplicationsamongpatientsundergoingaorticvalvereplacementintheunitedstates |