Advertisement

Comparison of Hospital Outcome of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes Mellitus (from the Nationwide Inpatient Sample)

Published:January 25, 2017DOI:https://doi.org/10.1016/j.amjcard.2016.12.026
      The comparative outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in diabetes mellitus (DM) patients are scarce. We aimed to assess and compare the outcomes of TAVR versus SAVR in DM patients using the Nationwide Inpatient Sample database from 2011 to 2013. A complete case analysis was performed for the multivariate analysis and cases with missing data were excluded. The primary end point was in-patient all-cause mortality and secondary outcomes were perioperative complications. An estimated 5,719 TAVR procedures and 65,096 SAVR procedures were performed among DM patients in the United States between 2011 and 2013. TAVR patients were older (80 ± 8.1 vs 70 ± 10, p <0.001), majority of them were women (45% vs 38%, p <0.001), and predominantly white race (total of 80%). The adjusted odds ratio (OR) for the primary outcome was significantly lower in TAVR patients (2.8% vs 3.6%, OR 0.63, p = 0.02). TAVR patients were also at lower risk for bleeding requiring transfusions (13% vs 20%, OR 0.43, p <0.01), cardiac complications (6.1% vs 14%, OR 0.34, p <0.01), respiratory complications (1.2% vs 3.7%, OR 0.26, p <0.01), postoperative sepsis (1.7% vs 3.6%, OR 0.45, p = 0.03), and acute myocardial infarction (2.5% vs 2.9%, OR 0.62, p <0.01), compared with SAVR patients. Conversely, TAVR patients were at increased risk for vascular complications (5.7% vs 3.9%, OR 1.5, p <0.01) and new pacemaker implantation (10% vs 5.7%, OR 1.5, p <0.01). The mean hospitalization cost was lower for TAVR than SAVR ($58,878 vs $63,869, p = 0.003). Length of stay (median 6 vs 8 days, p <0.001) was shorter in TAVR patients. In conclusion, TAVR may result in better in-hospital outcome than SAVR in DM patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carnero-Alcázar M.
        • Reguillo-Lacruz F.
        • Alswies A.
        • Villagrán-Medinilla E.
        • Maroto-Castellanos L.C.
        • Rodríguez-Hernández J.
        Short- and mid-term results for aortic valve replacement in octogenarians.
        Interact Cardiovasc Thorac Surg. 2010; 10: 549-554
        • Muñoz-García A.J.
        • del Valle R.
        • Trillo-Nouche R.
        • Elízaga J.
        • Gimeno F.
        • Hernández-Antolín R.
        • Teles R.
        • de Gama Ribeiro V.
        • Molina E.
        • Cequier A.
        • Urbano-Carrillo C.
        • Cruz-González I.
        • Payaslian M.
        • Patricio L.
        • Sztejfman M.
        • Iñiguez A.
        • Rodríguez V.
        • Scuteri A.
        • Caorsi C.
        • López-Otero D.
        • Avanzas P.
        • Alonso-Briales J.H.
        • Hernández-García J.M.
        • Morís C.
        • Ibero-American registry investigators
        The Ibero-American transcatheter aortic valve implantation registry with the CoreValve prosthesis. Early and long-term results.
        Int J Cardiol. 2013; 169: 359-365
        • Yoon S.H.
        • Ahn J.M.
        • Hayashida K.
        • Watanabe Y.
        • Shirai S.
        • Kao H.L.
        • Yin W.H.
        • Lee M.K.
        • Tay E.
        • Araki M.
        • Yamanaka F.
        • Arai T.
        • Lin M.S.
        • Park J.B.
        • Park D.W.
        • Kang S.J.
        • Lee S.W.
        • Kim Y.H.
        • Lee C.W.
        • Park S.W.
        • Muramatsu T.
        • Hanyu M.
        • Kozuma K.
        • Kim H.S.
        • Saito S.
        • Park S.J.
        • Asian TAVR Investigators
        Clinical outcomes following transcatheter aortic valve replacement in Asian population.
        JACC Cardiovasc Interv. 2016; 9: 926-933
        • Lindman B.R.
        • Pibarot P.
        • Arnold S.V.
        • Suri R.M.
        • McAndrew T.C.
        • Maniar H.S.
        • Zajarias A.
        • Kodali S.
        • Kirtane A.J.
        • Thourani V.H.
        • Tuzcu E.M.
        • Svensson L.G.
        • Waksman R.
        • Smith C.R.
        • Leon M.B.
        Transcatheter versus surgical aortic valve replacement in patients with diabetes and severe aortic stenosis at high risk for surgery: an analysis of the PARTNER Trial (Placement of Aortic Transcatheter Valve).
        J Am Coll Cardiol. 2014; 63: 1090-1099
        • Badheka A.O.
        • Patel N.J.
        • Panaich S.S.
        • Patel S.V.
        • Jhamnani S.
        • Singh V.
        • Pant S.
        • Patel N.
        • Patel N.
        • Arora S.
        • Thakkar B.
        • Manvar S.
        • Dhoble A.
        • Patel A.
        • Savani C.
        • Patel J.
        • Chothani A.
        • Savani G.T.
        • Deshmukh A.
        • Grines C.L.
        • Curtis J.
        • Mangi A.A.
        • Cleman M.
        • Forrest J.K.
        Effect of hospital volume on outcomes of transcatheter aortic valve implantation.
        Am J Cardiol. 2015; 116: 587-594
        • Singh V.
        • Patel S.V.
        • Savani C.
        • Patel N.J.
        • Patel N.
        • Arora S.
        • Panaich S.S.
        • Deshmukh A.
        • Cleman M.
        • Mangi A.
        • Forrest J.K.
        • Badheka A.O.
        Mechanical circulatory support devices and transcatheter aortic valve implantation (from the National Inpatient Sample).
        Am J Cardiol. 2015; 116: 1574-1580
        • Makkar R.R.
        • Fontana G.P.
        • Jilaihawi H.
        • Kapadia S.
        • Pichard A.D.
        • Douglas P.S.
        • Thourani V.H.
        • Babaliaros V.C.
        • Webb J.G.
        • Herrmann H.C.
        • Bavaria J.E.
        • Kodali S.
        • Brown D.L.
        • Bowers B.
        • Dewey T.M.
        • Svensson L.G.
        • Tuzcu M.
        • Moses J.W.
        • Williams M.R.
        • Siegel R.J.
        • Akin J.J.
        • Anderson W.N.
        • Pocock S.
        • Smith C.R.
        • Leon M.B.
        • PARTNER Trial Investigators
        Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.
        N Engl J Med. 2012; 366: 1696-1704
        • Hayashida K.
        • Lefèvre T.
        • Chevalier B.
        • Hovasse T.
        • Romano M.
        • Garot P.
        • Mylotte D.
        • Uribe J.
        • Farge A.
        • Donzeau-Gouge P.
        • Bouvier E.
        • Cormier B.
        • Morice M.C.
        Transfemoral aortic valve implantation new criteria to predict vascular complications.
        JACC Cardiovasc Interv. 2011; 4: 851-858
        • Dencker D.
        • Taudorf M.
        • Luk N.H.
        • Nielsen M.B.
        • Kofoed K.F.
        • Schroeder T.V.
        • Søndergaard L.
        • Lönn L.
        • De Backer O.
        Frequency and effect of access-related vascular injury and subsequent vascular intervention after transcatheter aortic valve replacement.
        Am J Cardiol. 2016; 118: 1244-1250
        • Giordana F.
        • D'Ascenzo F.
        • Nijhoff F.
        • Moretti C.
        • D'Amico M.
        • Biondi Zoccai G.
        • Sinning J.M.
        • Nickenig G.
        • Van Mieghem N.M.
        • Chieffo A.
        • Dumonteil N.
        • Tchetche D.
        • Barbash I.M.
        • Waksman R.
        • D'Onofrio A.
        • Lefevre T.
        • Pilgrim T.
        • Amabile N.
        • Codner P.
        • Kornowski R.
        • Yong Z.Y.
        • Baan J.
        • Colombo A.
        • Latib A.
        • Salizzoni S.
        • Omedè P.
        • Conrotto F.
        • La Torre M.
        • Marra S.
        • Rinaldi M.
        • Gaita F.
        Meta-analysis of predictors of all-cause mortality after transcatheter aortic valve implantation.
        Am J Cardiol. 2014; 114: 1447-1455
        • Konigstein M.
        • Ben-Assa E.
        • Banai S.
        • Shacham Y.
        • Ziv-Baran T.
        • Abramowitz Y.
        • Steinvil A.
        • Leshem Rubinow E.
        • Havakuk O.
        • Halkin A.
        • Keren G.
        • Finkelstein A.
        • Arbel Y.
        Periprocedural bleeding, acute kidney injury, and long-term mortality after transcatheter aortic valve implantation.
        Can J Cardiol. 2015; 31: 56-62
        • Paternoster G.
        • Guarracino F.
        Sepsis after cardiac surgery: from pathophysiology to management.
        J Cardiothorac Vasc Anesth. 2016; 30: 773-780
        • Gargiulo G.
        • Sannino A.
        • Capodanno D.
        • Perrino C.
        • Capranzano P.
        • Barbanti M.
        • Stabile E.
        • Trimarco B.
        • Tamburino C.
        • Esposito G.
        Impact of postoperative acute kidney injury on clinical outcomes after transcatheter aortic valve implantation: a meta-analysis of 5,971 patients.
        Catheter Cardiovasc Interv. 2015; 86: 518-527
        • Lindman B.R.
        • Goldstein J.S.
        • Nassif M.E.
        • Zajarias A.
        • Novak E.
        • Tibrewala A.
        • Vatterott A.M.
        • Lawler C.
        • Damiano R.J.
        • Moon M.R.
        • Lawton J.S.
        • Lasala J.M.
        • Maniar H.S.
        Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement.
        Heart. 2015; 101: 537-545
        • Adams D.H.
        • Popma J.J.
        • Reardon M.J.
        • Yakubov S.J.
        • Coselli J.S.
        • Deeb G.M.
        • Gleason T.G.
        • Buchbinder M.
        • Hermiller Jr., J.
        • Kleiman N.S.
        • Chetcuti S.
        • Heiser J.
        • Merhi W.
        • Zorn G.
        • Tadros P.
        • Robinson N.
        • Petrossian G.
        • Hughes G.C.
        • Harrison J.K.
        • Conte J.
        • Maini B.
        • Mumtaz M.
        • Chenoweth S.
        • Oh J.K.
        • U.S. CoreValve Clinical Investigators
        Transcatheter aortic-valve replacement with a self-expanding prosthesis.
        N Engl J Med. 2014; 370: 1790-1798
        • Balachandran S.
        • Lee A.
        • Denehy L.
        • Lin K.Y.
        • Royse A.
        • Royse C.
        • El-Ansary D.
        Risk factors for sternal complications after cardiac operations: a systematic review.
        Ann Thorac Surg. 2016; 102: 2109-2117
        • Karatas M.
        • Saylan S.
        • Kostakoglu U.
        • Yilmaz G.
        An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit.
        Pak J Med Sci. 2016; 32: 817-822