Perspective from Ashish Pershad, MD
Source/Disclosures
Source:

Kassis N, et al. Abstract III-52. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).

Kassis N, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.04.007.

Disclosures: Kassis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 21, 2020
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No difference by hospital volume in events after TAVR for bicuspid aortic valves

Perspective from Ashish Pershad, MD
Source/Disclosures
Source:

Kassis N, et al. Abstract III-52. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).

Kassis N, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.04.007.

Disclosures: Kassis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Low- and high-volume hospitals that performed transcatheter aortic valve replacement for bicuspid aortic valves had similar rates of in-hospital and 30-day outcomes, according to data presented at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.

These similarities were observed despite high-volume centers performing the procedure on patients with greater comorbid risk, according to the data, which were simultaneously published in JACC: Cardiovascular Interventions.

Nicholas Kassis, MD, resident physician at Cleveland Clinic Foundation, and colleagues analyzed data from 1,626 patients from the Nationwide Readmissions Database who underwent TAVR of bicuspid aortic valves between 2012 and 2017. Low-volume hospitals were defined as those that performed up to 100 total annual TAVR procedures, whereas high-volume hospitals were defined as those who performed more than 100 TAVR procedures per year.

Among the cohort, 53.1% underwent TAVR at high-volume hospitals. Bicuspid aortic valves accounted for 0.9% of all TAVR procedures at low-volume hospitals and 1% of procedures at high-volume hospitals.

Compared with low-volume hospitals, patients who underwent TAVR at high-volume hospitals were older (mean age, 68 years vs. 64 years), more likely to smoke tobacco (45.8% vs. 36.6%) and more likely to have renal failure (30.9% vs. 28.7%), HF (73% vs. 54.5%), prior MI (12.7% vs. 5.6%) and diabetes (29.2% vs. 23.3%; P < .001 for all).

The rate of in-hospital stroke was 3.6% at high-volume hospitals and 1.8% at low-volume hospitals (P = .034). In-hospital mortality occurred at a rate of 2.3% in high-volume hospitals compared with 3.8% at low-volume hospitals (P = .109). The risk for hospital discharge with disability after TAVR was lower at high-volume hospitals compared with low-volume hospitals after adjusting for sex, age, CHA2DS2-VASc score and comorbidities (OR = 0.655; 95% CI, 0.523-0.82). Hospital volume was not linked to different rates of mortality (OR = 0.689; 95% CI, 0.368-1.29) or in-hospital stroke (OR = 1.519; 95% CI, 0.775-2.976).

“Our study must be interpreted as strictly observational and inherently limited by its reliance on administrative reporting and inability to account for potential confounders including device type, operator experience, patient selection and, notably, the varied use of embolic protection devices across hospitals,” Kassis and colleagues wrote in JACC: Cardiovascular Interventions. “Nonetheless, our data reflect current practice and suggest that aggressive stroke prevention strategies should be pursued in patients with bicuspid aortic valves who are to undergo TAVR.” – by Darlene Dobkowski

References:

Kassis N, et al. Abstract III-52. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).

Kassis N, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.04.007.

Disclosures: Kassis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.