The Changing Landscape of Concomitant Procedures with Surgical Aortic Valve Replacements
Aakash M. Shah, BS1, Emaad Siddiqui, MD2, Nehal Dhaduk, BS1, Alexis Okoh, MD3, Justin Sambol, MD4
1Rutgers New Jersey Medical School, Newark, NJ, USA, 2Department of Medicine, New York University Langone Health, New York City, NY, USA, 3Heart and Lung Research Center, RWJ Barnabas Health; NBIMC, Newark, NJ, USA, 4Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
OBJECTIVE: Our study aims to assess the demographics, procedural outcomes and costs, and types of concomitant procedures associated with SAVR patients.
METHODS: The National Inpatient Sample was queried for all SAVR procedures from 2008 to 2017 using International Classification of Diseases-Ninth and Tenth Revision codes. Statistical analysis was performed on concomitant procedures after classification under six general categories: CABGs and mitral valve, tricuspid valve, atrial septal defect, aortic, and atrial appendage procedures.
RESULTS: From 2008-2017, the SAVR patient population became younger (65.48 ± 0.115 vs 68.02 ± 0.119; b= -0.305, r2=0.004, p<0.001) and consisted of a greater percentage of males (67.4% vs 63.3%; b=0.57%, r2=0.833, p<0.001), Hispanics (7.1% vs 5.6%), and Black people (5.9% vs 5.1%). On average, these patients had shorter hospital stays (10.1 ± 0.8 vs 11.41 ± 0.093; b=-0.125, r2=0.001, p<0.001) while their inflation-adjusted admission costs increased (,283 vs ,098; b=,344, r2=0.976, p<0.001). They also had increases in tricuspid valve (3.16% vs 1.22%), aortic (15.58% vs 11.18%), and atrial appendage (13.03% vs 9.57%) procedures, decreases in CABGs (49.0% vs 61.28%), and no change in mitral valve (12.29% vs 12.54%) and atrial septal defect (2.04% vs 1.98%) procedures.
CONCLUSIONS: As the number of TAVRs expands, particularly for high risk patients with aortic stenosis , a greater percentage of SAVRs are being performed in lower risk aortic stenosis patients and are including concomitant procedures. The main exception is in concomitant CABGs, which we suspected is due to the decrease in CABGs over the last decade.
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