Author + information
- Bhaskar Bhardwaj1,
- Siva Taduru1,
- Harsh Golwala2,
- Varun Kumar3,
- Nileshkumar Patel4,
- Nish Patel5,
- Shilpkumar Arora6,
- Mauricio Cohen7 and
- Sudarshan Balla8
- 1UMKC, Kansas City, Missouri, United States
- 2Brigham and Women's hospital, Boston, Massachusetts, United States
- 3Mt. Sinai St. Luke’s Roosevelt Hospital Center, New York, New York, Manhattan, New York, United States
- 4University of Miami, Miami, Florida, United States
- 5Mount Sinai Hospital, New York, New York, United States
- 6Mount Sinai St. Luke's Roosevelt, New York, New York, United States
- 7University of Miami Hospital, Miami, Florida, United States
- 8University of Missouri Columbia, Columbia, Missouri, United States
Patients with bicuspid aortic valve (BAV) stenosis were excluded from pivotal trials that led to approval of trans-catheter aortic valve replacement (TAVR) in the United States. There is limited data regarding the use of TAVR in BAV disease. We examined nationwide trends in use of TAVR and surgical aortic valve replacement (SAVR) in this patient population.
By using national inpatient sample (NIS) data, we identified patients with BAV with International Classification of Diseases-Ninth Revision-CM (ICD-9) code 746.4. Patients undergoing TAVR were identified using ICD-9 codes 35.05 and 35.06 in a study period of 2011-2014. Patients undergoing surgical aortic valve replacement (SAVR) were identified with ICD-9 procedure codes 35.21 and 35.22. Baseline characteristics and Elixhauser van Walraven Comorbidity indices were compared across treatment groups.
We examined 22,866 patients with a BAV stenosis. 22,443 (98.1%) patients underwent SAVR and the remaining 443 patients (1.9%) underwent TAVR in weighted patient sample. Compared to SAVR, patients undergoing TAVR were older (65±15 y vs. 59±14 y), with more co-morbidities (Elixhauser van Walraven Comorbidity indices 8.5 vs 6.5 p< 0.001). Over time, trends in utilization of TAVR for BAV stenosis increased from 0.4% in 2011 to 3.2% in 2014 (p trend<0.001). In addition, length of stay for TAVR decreased significantly [Mean (SD): 12.2 (8.2) days to 7.1 (5.9) days, p-value <0.001] as compared to SAVR [Mean (SD): 7.8 (5.3) days to 8.0 (9.8), p-value: 0.445].
Utilization of TAVR for BAV stenosis has been steadily increasing in United States with significant decrease in length of stay during the study period. With expansion of TAVR to intermediate risk population with aortic stenosis, the efficacy and safety of TAVR in BAV stenosis remains to be proven.
STRUCTURAL: Valvular Disease: Aortic