Author + information
- Ramez S. Nairooz,
- Naga Venkata Pothineni,
- Partha Sardar,
- Saurav Chatterjee,
- J. Abbott and
- David Shavelle
Introduction: Surgical aortic valve replacement (SAVR) remains the definitive treatment for many patients with aortic valve disease. We sought to explore the national and regional trends in SAVR after FDA approval of TAVR in 2011.
Methods: We examined the national inpatient sample database from 2009 until 2013. Clinical modification ICD-9-CM procedural codes for SAVR were used to identify eligible patients. We used descriptive statistics to express trends in percentages.
Results: In 2009, 73,740 patients underwent SAVR. The majority of cases (61.6%) were in the 65-84 age group, while 25.7% in 45-64 group and 6.6% in 85 and over. In 2013, two years after FDA approval of TAVR, SAVR decreased by 18.6% (56,390) compared with 2011, a steeper decline compared to the 6% decrease in 2011 compared to 2009 (P-trend 0.08). Patients aged 65-84 underwent less SAVR in 2013 compared to 2011 (34,685 vs. 42,426), an 18.2% decrease compared with a 7% decrease in 2009-2011 (P-trend not significant [NS]). In patients 85 and older, SAVR declined drastically from 5,493 in 2011 to 3,520 in 2013, a 35.9% drop compared with an increase of 11.6% from 2009 to 2011 (P-trend 0.02). Similarly 45-64 age group had a 15.9% decline in 2013 compared to 2011, as opposed to a 5.8% decline from 2009-2011 (P-trend NS). Regionally, in the West, SAVR significantly decreased from 15,817 in 2011 to 7,520 in 2013, a 52.4% decline. Among hospitals located in the South and the Northeast, SAVR decreased 9.5% and 22%, respectively, since TAVR's approval. The Midwest surprisingly exhibited a 9.1% increase in SAVR volumes. In the West, in-hospital death rates increased significantly from 2.8% to 4.2% as opposed to a steady decline in death rates in all other regions. Nationally, in-hospital mortality was mostly unchanged at 3.79% in 2009 compared with 3.01% in 2013. While by age groups, only 85 and older had a larger decline of in-hospital mortality from 2011-2013 compared to 2009-2011 (1% vs 0.55% decline).
Conclusions: Overall SAVR decreased more after TAVR approval compared to prior with regional variations. Patients aged 85 and older had the steepest declines in SAVR volumes after TAVR approval.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Valvular Disease Populations at Risk
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1104-030
- 2017 American College of Cardiology Foundation