Transcatheter aortic valve implantation decreases the rate of unoperated aortic stenosis

S. Chris Malaisrie, Eric Tuday, Brittany Lapin, Edward Wang, Richard Lee, Edwin C. McGee, Charles Davidson, Patrick M. McCarthy

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective: Aortic valve replacement (AVR) is the standard treatment for severe, symptomatic aortic stenosis (AS). However, many patients are not referred for surgery and fewer undergo AVR. Transcatheter aortic valve implantation (TAVI) has emerged as a solution for high-risk AS patients. We sought to measure the impact of TAVI on the undertreatment of AS. Methods: Patients with AS were identified by retrospective medical record review and evaluation of echocardiograms were performed in a single-center tertiary-care institution. A total of 179, 183, 214, and 265 patients had AS in 2006, 2007, 2008, and 2009, respectively, with the introduction of TAVI occurring in 2008 and continuing through 2009. The primary endpoints were the rates of unoperated AS and surgical referral. Results: The rates of unoperated AS were 50.6% before TAVI and 40.7% after TAVI (p=0.002). Referral rates to surgery were 63.6% before TAVI and 74.1% after TAVI (p=0.003). Reasons for nonreferral were patient-family decision, perceived high operative risk, and the presence of comorbidities. Operative mortality was 3.7% and not statistically significant different between years. Three-year patient survival was 82.5% in the AVS group and 43.9% in the UNOP group (P<0.001). Conclusions: The introduction of TAVI was associated with an increase in surgical referrals and a decrease in the rate of unoperated AS. This positive impact was due to increases in both TAVI and AVR volume. Increased volume was not associated with worse patient survival. A significant population of patients with AS are still treated medically.

Original languageEnglish (US)
Pages (from-to)43-48
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume40
Issue number1
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Referral and Consultation
Transcatheter Aortic Valve Replacement
Survival
Tertiary Care Centers
Medical Records
Comorbidity
Mortality

Keywords

  • Aortic stenosis
  • Aortic valve replacement
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter aortic valve implantation decreases the rate of unoperated aortic stenosis. / Malaisrie, S. Chris; Tuday, Eric; Lapin, Brittany; Wang, Edward; Lee, Richard; McGee, Edwin C.; Davidson, Charles; McCarthy, Patrick M.

In: European Journal of Cardio-thoracic Surgery, Vol. 40, No. 1, 01.07.2011, p. 43-48.

Research output: Contribution to journalArticle

Malaisrie, S. Chris ; Tuday, Eric ; Lapin, Brittany ; Wang, Edward ; Lee, Richard ; McGee, Edwin C. ; Davidson, Charles ; McCarthy, Patrick M. / Transcatheter aortic valve implantation decreases the rate of unoperated aortic stenosis. In: European Journal of Cardio-thoracic Surgery. 2011 ; Vol. 40, No. 1. pp. 43-48.
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abstract = "Objective: Aortic valve replacement (AVR) is the standard treatment for severe, symptomatic aortic stenosis (AS). However, many patients are not referred for surgery and fewer undergo AVR. Transcatheter aortic valve implantation (TAVI) has emerged as a solution for high-risk AS patients. We sought to measure the impact of TAVI on the undertreatment of AS. Methods: Patients with AS were identified by retrospective medical record review and evaluation of echocardiograms were performed in a single-center tertiary-care institution. A total of 179, 183, 214, and 265 patients had AS in 2006, 2007, 2008, and 2009, respectively, with the introduction of TAVI occurring in 2008 and continuing through 2009. The primary endpoints were the rates of unoperated AS and surgical referral. Results: The rates of unoperated AS were 50.6{\%} before TAVI and 40.7{\%} after TAVI (p=0.002). Referral rates to surgery were 63.6{\%} before TAVI and 74.1{\%} after TAVI (p=0.003). Reasons for nonreferral were patient-family decision, perceived high operative risk, and the presence of comorbidities. Operative mortality was 3.7{\%} and not statistically significant different between years. Three-year patient survival was 82.5{\%} in the AVS group and 43.9{\%} in the UNOP group (P<0.001). Conclusions: The introduction of TAVI was associated with an increase in surgical referrals and a decrease in the rate of unoperated AS. This positive impact was due to increases in both TAVI and AVR volume. Increased volume was not associated with worse patient survival. A significant population of patients with AS are still treated medically.",
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