The Journal of thoracic and cardiovascular surgery · 2024
Impact of transcatheter aortic valve replacement use ratio on outcomes in patients with aortic valve disease.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Marghitu Theodore, Roberts Sophia H, He June, Kouchoukos Nicholas, Kachroo Puja, Roberts Harold, Damiano Ralph, Zajarias Alan, Sintek Marc, Lasala John, Brescia Alexander A, Kaneko Tsuyoshi
Аннотация
OBJECTIVE: Use of the Heart Team has been the standard of care for the treatment of aortic valve disease; however, its efficacy has not been evaluated. We sought to analyze its impact using the transcatheter aortic valve replacement (TAVR) use ratio (number of TAVR/total aortic valve replacement [AVR] volume) on TAVR, surgical aortic valve replacement (SAVR), and overall AVR outcomes.
METHODS: We analyzed all TAVRs and SAVRs sampled by the National Readmissions Database between 2016 and 2020. Hospitals were stratified into quartiles on the basis of their TAVR/AVR ratio. Centers with a ratio below the first quartile were considered "low ratio," centers in the second and the third quartile "balanced ratio," and centers above the third quartile "high ratio." Primary outcomes were 30-day mortality and complication rate, which included stroke, renal failure, heart block, pacemaker placement, and valve regurgitation.
RESULTS: For overall AVR outcomes, centers with a balanced ratio had lower mortality compared with centers with low ratio (1.9% vs 2.1%, P = .01) and lower complication rate compared with centers with high ratio (34.8% vs 36.8%, P < .001). Centers with a balanced ratio had lower TAVR complication rate compared with centers with low ratio (37.3% vs 39%, P < .001). For SAVR outcome, centers with an balanced ratio had lower post-SAVR mortality (2.1% vs 2.6%, P < .001) and complication rate (28.6% vs 30.3%, P < .001) than centers with high ratio.
CONCLUSIONS: Centers with balanced TAVR ratios had superior outcomes compared with centers with low or high ratios. These data support the use of a balanced Heart Team to optimize AVR outcomes.
METHODS: We analyzed all TAVRs and SAVRs sampled by the National Readmissions Database between 2016 and 2020. Hospitals were stratified into quartiles on the basis of their TAVR/AVR ratio. Centers with a ratio below the first quartile were considered "low ratio," centers in the second and the third quartile "balanced ratio," and centers above the third quartile "high ratio." Primary outcomes were 30-day mortality and complication rate, which included stroke, renal failure, heart block, pacemaker placement, and valve regurgitation.
RESULTS: For overall AVR outcomes, centers with a balanced ratio had lower mortality compared with centers with low ratio (1.9% vs 2.1%, P = .01) and lower complication rate compared with centers with high ratio (34.8% vs 36.8%, P < .001). Centers with a balanced ratio had lower TAVR complication rate compared with centers with low ratio (37.3% vs 39%, P < .001). For SAVR outcome, centers with an balanced ratio had lower post-SAVR mortality (2.1% vs 2.6%, P < .001) and complication rate (28.6% vs 30.3%, P < .001) than centers with high ratio.
CONCLUSIONS: Centers with balanced TAVR ratios had superior outcomes compared with centers with low or high ratios. These data support the use of a balanced Heart Team to optimize AVR outcomes.