Author + information
- Ahmad Alkhalil1,
- Richard Hajjar2,
- David Song3,
- Adamantios Tsangaris4,
- Akhtar Amin5,
- Harveen Lamba6,
- Eman Rashed5,
- Shashank Jain5,
- Shervin Golbari5 and
- Homam Ibrahim7
- 1Rutgers University Hospitals, Newark, New Jersey, United States
- 2Rutgers University Hospial, Newark, New Jersey, United States
- 3Rutgers University Hospital-Newark, Newark, New Jersey, United States
- 4Rutgers New Jersey Medical School, Newark, New Jersey, United States
- 5Rutgers University Hospital, Newark, New Jersey, United States
- 6University Hospitals Cleveland Medical Center, Cleveland Heights, Ohio, United States
- 7NYU Langone Medical Center, New York, NY, New York, New York, United States
Transfemoral (TF) and transapical (TA) approaches are the two most common routs for transcatheter aortic valve replacement (TAVR). There is little known about the real world utilization of these approaches and their in-hospital clinical outcomes.
Patients who underwent TAVR (n=40900) between 2012 and 2014 were identified in the National Inpatient Sample (NIS). The cohort was stratified into two groups: TF (n=32715) and TA (n=8185). Baseline characteristics and in-hospital outcomes were compared. Propensity-score matching was used to minimize selection bias.
TAVR yearly operative volume grew rapidly from 7640 (in 2012) to 19815 (in 2014). TA approach was used in 20 % of the patient with significant variation between the years: 15.7% (2011) vs 28.7% (2013) vs 15.8% (2014), p<0.001. TF patients were older (81.3 vs 80 years), had less peripheral vascular disease (28.2% vs 35.6%), and were less likely to be female (46% vs 54%), (P for all < 0.01). TAVR Overall in-hospital mortality was (4%). After propensity-score matching, in-hospital mortality was similar between TF and TA (5.3% vs 5.5%, p=0.8). Compared with TA, TF was associated with shorter length of stay (LOS) (6 vs 7 days, p<0.001), lower hospitalization charges ($235,199 vs $250,815, p=0.01), lower in-hospital complications (48.4% vs 53.2%, p=0.01) and higher rate of home discharge (32.3% vs 24.3%, p<0.001).
TAVR yearly operative volume in USA almost tripled between 2012 and 2014. Overall, TA approach was used in 20 % of the cases. TA and TF have comparable in-hospital mortality, however TF was associated with shorter LOS, lower in-hospital complications, lower hospitalization charges, and higher rate of home discharge.
STRUCTURAL: Valvular Disease: Aortic