Author + information
- Brian Butera,
- Fernando Fleischman,
- Anna Belikova,
- Christina Martinez,
- Anilkumar Mehra and
- David M. Shavelle
Access to contemporary device based therapy in cardiovascular medicine is often limited by socioeconomic status. Although transcatheter aortic valve implantation (TAVI) is widely available in the United States, use of this therapy in a safety net hospital has not been described. The Objective of the current analysis is to describe a cohort of indigent patients with severe aortic stenosis (AS) undergoing TAVI at an urban safety net hospital.
From June, 2011 until September, 2016, 401 patients underwent TAVI at Keck Medicine of USC. Patients with insurance (n=350) were excluded yielding 49 indigent patients. Patient characteristics, procedural variables and outcome were collected using the STS/ACC/TVT Registry and were compared to PARTNERS High Risk Study.
Mean age was 71±13 years, 55% male with mean ejection fraction 47±19%. Mean STS Score was 4.4±3.5; 7 patients (14%) with an STS score ≥ 8. Eighty-six percent of patients had high risk co-morbid conditions, not adequately captured by traditional risk score assessment. Three patients (6%) had a hostile chest, 5 (10%) had cirrhosis, 9 (18%) had an ejection fraction < 30% and 11 (22%) had frailty. Patient characteristics were significantly different compared to those enrolled in PARTNERS High Risk Study (Table). Device success was 100% and device migration/embolization was 0%. In-hospital mortality and 30-Day mortality were both 0%.
Indigent patients receiving transcatheter aortic valve implantation at a safety net hospital have unique high risk features with 86% of patients not adequately described by traditional risk score assessment. Procedural and short term outcome was excellent suggesting that this therapy can be effectively applied in this patient cohort. Additional follow up is required to ensure acceptable long term outcome.