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Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Mediastinal Radiation
- Source :
- JACC. Cardiovascular interventions. 13(22)
- Publication Year :
- 2020
-
Abstract
- Objectives This study sought to evaluate the trends and outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among patients with prior mediastinal radiation from a national database. Background There is a paucity of data about the temporal trends and outcomes of TAVR versus SAVR in patients with prior mediastinal radiation. Methods The National Inpatient Sample database years 2012 to 2017 was queried for hospitalizations of patients with prior mediastinal radiation who underwent isolated AVR. Using multivariable analysis, the study compared the outcomes of TAVR versus SAVR. The main study outcome was in-hospital mortality. Results The final analysis included 3,675 hospitalizations for isolated AVR; of whom 2,170 (59.1%) underwent TAVR and 1,505 (40.9%) underwent isolated SAVR. TAVR was increasingly performed over time (ptrend = 0.01), but there was no significant increase in the rates of utilization of SAVR. The following factors were independently associated with TAVR utilization: older age, chronic lung disease, coronary artery disease, chronic kidney disease, prior cerebrovascular accidents, prior coronary artery bypass grafting, and larger-sized hospitals, while women were less likely to undergo TAVR. Compared with SAVR, TAVR was associated with lower in-hospital mortality (1.2% vs. 2.0%, adjusted odds ratio: 0.27; 95% confidence interval: 0.09 to 0.79; p = 0.02). TAVR was associated with lower rates of acute kidney injury, use of mechanical circulatory support, bleeding and respiratory complications, and shorter length of hospital stay. TAVR was associated with higher rates of pacemaker insertion. Conclusions This nationwide observational analysis showed that TAVR is increasingly performed among patients with prior mediastinal radiation. TAVR provides an important treatment option for this difficult patient population with desirable procedural safety when using SAVR as a benchmark.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
030204 cardiovascular system & hematology
Risk Assessment
Coronary artery disease
Transcatheter Aortic Valve Replacement
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Aortic valve replacement
Valve replacement
Risk Factors
medicine
Humans
030212 general & internal medicine
Hospital Mortality
Heart Valve Prosthesis Implantation
business.industry
Acute kidney injury
Odds ratio
Aortic Valve Stenosis
medicine.disease
Confidence interval
Surgery
medicine.anatomical_structure
Treatment Outcome
Aortic Valve
Female
Cardiology and Cardiovascular Medicine
business
Kidney disease
Artery
Subjects
Details
- ISSN :
- 18767605
- Volume :
- 13
- Issue :
- 22
- Database :
- OpenAIRE
- Journal :
- JACC. Cardiovascular interventions
- Accession number :
- edsair.doi.dedup.....b8a2fa4eb8565672376e870b36837391