Author + information
- Received April 4, 2018
- Revision received June 21, 2018
- Accepted July 3, 2018
- Published online October 17, 2018.
- Harun Kundi, MDa,
- Jordan B. Strom, MD, MSca,
- Linda R. Valsdottir, MSa,
- Sammy Elmariah, MDb,
- Jeffrey J. Popma, MDa,
- Changyu Shen, PhDa and
- Robert W. Yeh, MD, MSca,∗ ()
- aRichard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- bCardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Robert W. Yeh, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, Fourth Floor, Boston, Massachusetts 02215.
Objectives This study sought to evaluate the trends in isolated surgical aortic valve replacement (SAVR) procedures across hospitals with different transcatheter aortic valve replacement (TAVR) volumes among Medicare beneficiaries.
Background The volume of TAVR has increased in the United States since its approval, now exceeding that of isolated SAVR.
Methods Hospitalizations of adults (≥18 years) with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for SAVR (35.21 or 35.22) or TAVR (35.05 or 35.06) who were included in the Medicare Provider Analysis and Review database between January 1, 2011, and December 31, 2014, were included. Trends in isolated SAVR patient characteristics, procedural volumes, and outcomes by quartile (Q) of hospital-level TAVR use were assessed over the study period.
Results A total of 37,705 isolated SAVR procedures were analyzed for the study. The annual volume of isolated SAVR procedures decreased in hospitals performing the largest number of TAVR procedures (Q3: 1,557 in 2011 to 1,391 in 2014; and Q4: 2,607 in 2011 to 1,791 in 2014). Thirty-day and 1-year mortality after SAVR also declined over the study period in hospitals with the largest TAVR volume (annual change rate in mortality for Q3: −16.4%, p < 0.001; Q4: −20.8%, p < 0.001).
Conclusions The advent of TAVR was associated with a reduction in isolated SAVR volumes, a decrease in comorbidities among patients undergoing SAVR, and corresponding reductions in observed short- and long-term SAVR mortality among hospitals performing the greatest number of TAVRs.
Members of the study team are supported by funding from the National Heart, Lung, and Blood Institute (1F32HL1407-11 [J.B.S.], R01HS024520-01 [C.S.], and 1R01HL136708-01 [R.W.Y.]). Dr. Elmariah is funded by the American Heart Association (14 FTF20440012). The funding organizations had no role in the final edits or submission of this manuscript. Dr. Elmariah has received institutional research support from Siemens and Boehringer Ingelheim Pharmaceuticals, Inc.; and consulting fees from Medtronic and Edwards Lifesciences. Dr. Popma has received grants from Boston Scientific, Medtronic, Abbott Vascular, Edwards Lifesciences, and Direct Flow Medical; is on the Advisory Board of Edwards Lifesciences; and received personal fees from Boston Scientific, Cordis, and Direct Flow Medical, outside the submitted work. Dr. Yeh has received investigator-initiated grant funding from Abiomed; grant support from Boston Scientific; and consulting fees from Abbott, Medtronic, Boston Scientific, and Teleflex, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 4, 2018.
- Revision received June 21, 2018.
- Accepted July 3, 2018.
- 2018 American College of Cardiology Foundation
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