Author + information
- Received February 25, 2019
- Revision received April 22, 2019
- Accepted April 30, 2019
- Published online November 4, 2019.
- Philip S. Hall, MDa,
- Colin I. O’Donnell, PhDb,
- Verghese Mathew, MDc,
- Santiago Garcia, MDd,e,
- Anthony A. Bavry, MD, MPHf,
- Subhash Banerjee, MDg,
- Hani Jneid, MDh,
- Ali E. Denktas, MDh,
- John C. Giacomini, MDi,
- Paul M. Grossman, MDj,
- Kul Aggarwal, MDk,
- Jeffrey M. Zimmet, MD, PhDl,
- Elaine E. Tseng, MDl,
- Leo Gozdecki, DOc,
- Lucas Burke, MDc,
- Stefan C. Bertog, MDe,
- Maurice Buchbinder, MDi,
- Mary E. Plomondon, MSPH, PhDb,
- Stephen W. Waldo, MDb and
- Kendrick A. Shunk, MD, PhDl,∗ ()
- aUniversity of North Carolina Rex Healthcare, Raleigh, North Carolina
- bUniversity of Colorado and Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- cLoyola University Stritch College of Medicine, Maywod, Illinois
- dUniversity of Minnesota and VA Medical Center, Minneapolis, Minnesota
- eValve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota
- fUniversity of Florida and VA Medical Center, Gainesville, Florida
- gUniversity of Texas, Southwestern and North Texas VA Medical Center, Dallas, Texas
- hBaylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas
- iStanford University and VA Medical Center, Palo Alto, California
- jUniversity of Michigan and VA Medical Center, Ann Arbor, Michigan
- kUniversity of Missouri and Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri
- lUniversity of California and Veterans Affairs Medical Center, San Francisco, California
- ↵∗Address for correspondence:
Dr. Kendrick Shunk, University of California and Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, California, 94121.
Objectives This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days.
Background Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers.
Methods Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization.
Results Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). Nonfemoral access (odds ratio: 1.74; 95% confidence interval [CI]: 1.10 to 2.74), heart failure (odds ratio: 2.51; 95% CI: 1.83 to 3.44), and atrial fibrillation (odds ratio: 1.40; 95% CI: 1.01 to 1.95) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63).
Conclusions Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.
Dr. Hall has received research funding from the American College of Cardiology Foundation/Merck Research Award 2016. Dr. Garcia is a consultant for Surmodics, Osprey Medical, Medtronic, Edwards Lifesciences, and Boston Scientific; and has received research grants from Edwards Lifesciences and the VA Office of Research and Development. Dr. Bavry is a proctor for Edwards Lifesciences; and has received an honorarium from the American College of Cardiology. Dr. Banerjee has received speaker honoraria from AstraZeneca, Cardiovascular Systems, Gore, and Medtronic; and has received institutional research grants from Boston Scientific and Merck. Dr. Tseng has received research grants from the National Institutes of Health (5R01HL119857-04), a University of California-San Francisco, Surgical Innovations grant, VA CSP #588 Regroup, and Cryolife (Perclot trial); and is a founder of ReValve Med. Dr. Waldo receives unrelated investigator-initiated research support to the Denver Research Institute from Abiomed, Cardiovascular Systems, and Merck Pharmaceuticals. Dr. Shunk is a consultant for Medeon Bio, TransAortic Medical, and Terumo; and has received institutional research support from Siemens Medical Systems, Cardiovascular Systems, and Svelte Medical Systems. The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. government. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 25, 2019.
- Revision received April 22, 2019.
- Accepted April 30, 2019.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.