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Transcatheter Versus Surgical Aortic Valve Replacement in the United States (From the Nationwide Readmission Database) - 06/05/21

Doi : 10.1016/j.amjcard.2021.02.031 
Tomo Ando, MD a, , Takayuki Onishi, MD a, Toshiki Kuno, MD, PhD b, Alexandros Briasoulis, MD, PhD c, Hisato Takagi, MD, Ph.D. d, Cindy L. Grines, MD e, Kei Hatori, MD a, Tetsuya Tobaru, MD a, Aaqib H. Malik, MD, MPH f, Hasan Ahmad, MD f
a Kawasaki Saiwai Hospital, Division of Cardiology, Kawasaki, Kanagawa, Japan 
b Mount Sinai Beth Israel Medical Center, Division of Internal Medicine, New York, New York 
c University of Iowa Hospitals and Clinics, Division of Cardiology Iowa, Iowa 
d Shizuoka Medical Center, Division of Cardiothoracic Surgery, Shizuoka, Japan 
e Northside Hospital Cardiovascular Institute, Atlanta, Georgia 
f Westchester Medical Center and New York Medical College, Department of Internal Medicine, Valhalla, New York 

Corresponding author: Tel: 044-544-4611; fax: 044-549-4858

Riassunto

Clinical outcomes of transcatheter aortic valve implantation (TAVI) have significantly improved with the accumulation of operator and institution experience as well as the wide use of newer generation devices. There is limited data on TAVI outcomes compared with surgical aortic valve replacement (SAVR) in contemporary practice in the United States. We queried the 2018 Nationwide Readmission Database of the United States. International Classification Diagnosis code 10 was used to extract TAVI and SAVR admissions. A propensity-matched cohort was created to compare TAVI and SAVR outcomes. A weighted 48,349 TAVI and 24,896 SAVR for aortic stenosis were included and 4.9% of TAVI were performed with an embolic protection device. In propensity-matched cohort (12,708 TAVI and 12,708 SAVR), TAVI conferred lower in-hospital mortality (1.7% vs 3.8%), acute kidney injury (11.3% vs 22.9%), and transfusion rate (5.9% vs. 20.6%) whereas new pacemaker rate was higher in TAVI compared with SAVR (10.5% vs. 7.0%) (all p values < 0.001). Stroke rate was similar between TAVI and SAVR (1.5% vs. 1.5%) (p value = 0.79). The routine discharge was more frequent (66.9% vs 25.8%) and length of stay was shorter (4.8 vs. 9.8 days) in TAVI than SAVR. Hospitalization cost was higher in SAVR than TAVI (51,962 vs 57,754 U.S. dollars) (all p values < 0.001). In-hospital mortality was also lower in TAVI compared with isolated SAVR. TAVI was performed more frequently than SAVR in 2018 in the United States with lower in-hospital mortality of TAVI compared with both SAVR and isolated SAVR.

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 There was no external funding for this study.


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Vol 148

P. 110-115 - giugno 2021 Ritorno al numero
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