Author + information
- Arka Chatterjee1,
- Nirmanmoh Bhatia2,
- Manyoo Agarwal3,
- Massoud Leesar4,
- Mark Sasse5,
- Thomas Watts6,
- Sahil Agrawal7,
- Divyanshu Mohananey8 and
- Mark Law6
- 1UAB, Birmingham, Alabama, United States
- 2Vanderbilt University Medical Center, Nashville, Tennessee, United States
- 3University of Tennessee, memphis, Tennessee, United States
- 4University of Alabama-Birmingham, Birmingham, Alabama, United States
- 5University of Alabama Birmingham, Vestavia, Alabama, United States
- 6University of Alabama at Birmingham, Birmingham, Alabama, United States
- 7St Luke’s University Hospital, Bethlehem, PA, USA, Allentown, Pennsylvania, United States
- 8Cleveland Cinic, Cleveland, Ohio, United States
Balloon valvuloplasty (BV) is commonly performed for young adults with bicuspid aortic valves and aortic stenosis. However there is paucity of data regarding safety and feasibility of same.
We analyzed the National Inpatient Sample (NIS) database from 2003 to 2014 and compared clinical characteristics for all patients with a diagnosis of bicuspid aortic valve who underwent BV with the aim to estimate need for urgent surgical aortic valve replacement (SAVR) as a safety outcome.
A total of 2596 unique patients were analyzed [median age 47 years (IQR 19); 83.5% Caucasian; 23.3% female]. 3.8% (n=98) patients had concomitant cardiogenic shock. 1.5% (n=38) patients died during the hospital stay; 8.2% (n=215) required SAVR during same hospital stay. Median length of stay (LOS) was 6 (IQR 3) days. Patients requiring SAVR had longer LOS (9.9 v 5; p < 0.01). On multivariate analysis, increasing age (median age 57 v 46; p < 0.01; Odds ratio per year increase: 1.04; 95% confidence intervals: 1.02-1.05) and African American (OR: 5.5; 95% CI:2.9-10.2) or Hispanic race (OR: 10.3; 95% CI: 4.3-25) increased risk of needing SAVR whereas the procedure being performed at larger hospitals (OR: 0.27; 95% CI: 0.13-0.56) and urban teaching hospitals (OR: 0.10; 95% CI: 0.03-0.35) provided protection from same. Amongst patients who received BV only, 0.6% (n=14) required blood transfusion, 1.8% (n=44) had post procedural stroke and 1.6% (n=39) had pericardial tamponade.
Risk of requiring urgent SAVR after BV for bicuspid aortic valve stenosis is not trivial in this large national database. The risk increases with age, may have a racial determinant and is mitigated by the procedure being performed at larger teaching hospitals. In the absence of randomized / registry data, these results will help in better decision making and patient counselling prior to these procedures.
STRUCTURAL: Valvular Disease: Aortic