TY - JOUR
T1 - Balloon-expandable transcatheter aortic valve replacement outcomes by procedure location
T2 - Catheterization laboratory versus operating room
AU - Nguyen, Tom C.
AU - Keegan, Patricia
AU - Nguyen, Stephanie
AU - Loyalka, Pranav
AU - Kaneko, Tsuyoshi
AU - Shah, Pinak B.
AU - Grubb, Kendra J.
AU - Babaliaros, Vasilis C.
N1 - Funding Information:
The authors thank Jason Hokama, PhD (Edwards Lifesciences) and Ke Xu, PhD (Edwards Lifesciences) for assistance with tables and figures and technical accuracy of the manuscript. Sources of funding: None. Disclosures: Statistical analyses were performed by Edwards Lifesciences. The views or opinions presented here do not represent those of the American College of Cardiology, the Society of Thoracic Surgeons, or the STS/ACC TVT Registry. TCN reports receiving consultant fees from Edwards Lifesciences, Abbott and LivaNova. TK reports receiving consulting and proctoring fees from Edwards Lifesciences, Medtronic, and Abbott. PBS reports receiving consulting and proctoring fees from Edwards Lifesciences. KJG reports receiving proctoring fees from Edwards Lifesciences and Medtronic and is on the advisory board for Medtronic and Boston Scientific. VCB reports receiving consultant fees from Edwards Lifesciences. PK, PL and SN have no conflicts of interest or financial disclosures.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Background: The impact of procedure location on clinical outcomes after TAVR remains unclear. We aimed to compare short-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) in the catheterization laboratory (CATH) versus surgical operating room (OR). Methods: A retrospective review of 63,581 trans-femoral TAVR patients using balloon-expandable valves from 2015 to 2018 were captured utilizing the TVT Registry. Propensity score matching was performed using 24 covariates resulting in 2 risk-adjusted groups. Patients were further stratified by STS Risk Score with outcomes compared. Results: Propensity score matching resulted in 24,160 risk-matched CATH and OR patient pairs. Short-term clinical outcomes including all-cause mortality, stroke, major vascular complications, life-threatening bleeding, and new dialysis were similar between CATH and OR (p = all ns). There was no difference in conversion to open heart surgery between CATH and OR with both occurring at a very low rate (0.4% vs. 0.5%, p = 0.07). Moreover, the 30-day survival post-conversion was similar whether TAVR was performed in CATH versus OR (43.3% and 49.7%, p = 0.28). When stratified by STS Risk Score, there was no difference in conversion to surgery or 30-day mortality in low and intermediate risk patients between CATH and OR. For high risk patients, however, conversion to surgery was lower in CATH vs. OR (0.2% vs. 0.4%, p = 0.04) with no difference in 30-day survival (46% vs. 43%, p = 0.94). Conclusions: Procedure location has minimal impact on TAVR procedural and 30-day outcomes with a very low conversion to open surgery rate between CATH versus OR for low, intermediate, and high-risk patients.
AB - Background: The impact of procedure location on clinical outcomes after TAVR remains unclear. We aimed to compare short-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) in the catheterization laboratory (CATH) versus surgical operating room (OR). Methods: A retrospective review of 63,581 trans-femoral TAVR patients using balloon-expandable valves from 2015 to 2018 were captured utilizing the TVT Registry. Propensity score matching was performed using 24 covariates resulting in 2 risk-adjusted groups. Patients were further stratified by STS Risk Score with outcomes compared. Results: Propensity score matching resulted in 24,160 risk-matched CATH and OR patient pairs. Short-term clinical outcomes including all-cause mortality, stroke, major vascular complications, life-threatening bleeding, and new dialysis were similar between CATH and OR (p = all ns). There was no difference in conversion to open heart surgery between CATH and OR with both occurring at a very low rate (0.4% vs. 0.5%, p = 0.07). Moreover, the 30-day survival post-conversion was similar whether TAVR was performed in CATH versus OR (43.3% and 49.7%, p = 0.28). When stratified by STS Risk Score, there was no difference in conversion to surgery or 30-day mortality in low and intermediate risk patients between CATH and OR. For high risk patients, however, conversion to surgery was lower in CATH vs. OR (0.2% vs. 0.4%, p = 0.04) with no difference in 30-day survival (46% vs. 43%, p = 0.94). Conclusions: Procedure location has minimal impact on TAVR procedural and 30-day outcomes with a very low conversion to open surgery rate between CATH versus OR for low, intermediate, and high-risk patients.
KW - Catheterization laboratory
KW - Conversion to open surgery
KW - Hybrid operating room
KW - STS risk score
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85066783619&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2019.04.007
DO - 10.1016/j.carrev.2019.04.007
M3 - Article
C2 - 31178348
AN - SCOPUS:85066783619
SN - 1553-8389
VL - 21
SP - 149
EP - 154
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 2
ER -