Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis
Introduction. The last decade has witnessed major evolution and shifts in the use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Included among the shifts has been the advent of alternative access sites for TAVR. Consequently, transapical access (TA) has become sig...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2022/5688026 |
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| author | Sumit Sohal Harsh Mehta Krishna Kurpad Sheetal Vasundara Mathai Rajiv Tayal Gautam K. Visveswaran Najam Wasty Sergio Waxman Marc Cohen |
| author_facet | Sumit Sohal Harsh Mehta Krishna Kurpad Sheetal Vasundara Mathai Rajiv Tayal Gautam K. Visveswaran Najam Wasty Sergio Waxman Marc Cohen |
| author_sort | Sumit Sohal |
| collection | DOAJ |
| description | Introduction. The last decade has witnessed major evolution and shifts in the use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Included among the shifts has been the advent of alternative access sites for TAVR. Consequently, transapical access (TA) has become significantly less common. This study analyzes in detail the trend of TA access for TAVR over the course of 7 years. Methods. The national inpatient sample database was reviewed from 2011–2017 and patients with AS were identified by using validated ICD 9-CM and ICD 10-CM codes. Patients who underwent TAVR through TA access were classified as TA-TAVR, and any procedure other than TA access was classified as non-TA-TAVR. We compared the yearly trends of TA-TAVR to those of non-TA-TAVR as the primary outcome. Results. A total of 3,693,231 patients were identified with a diagnosis of AS. 129,821 patients underwent TAVR, of which 10,158 (7.8%) underwent TA-TAVR and 119,663 (92.2%) underwent non-TA-TAVR. After peaking in 2013 at 27.7%, the volume of TA-TAVR declined to 1.92% in 2017 (p<0.0001). Non-TA-TAVR started in 2013 at 72.2% and consistently increased to 98.1% in 2017. In-patient mortality decreased from a peak of 5.53% in 2014 to 3.18 in 2017 (p=0.6) in the TA-TAVR group and from a peak of 4.51% in 2013 to 1.24% in 2017 (p=0.0001) in the non-TA-TAVR group. Conclusion. This study highlights a steady decline in TA access for TAVR, higher inpatient mortality, increased length of stay, and higher costs compared to non-TA-TAVR. |
| format | Article |
| id | doaj-art-b6221b32ff4a4be3938c51b75cc0e06a |
| institution | Kabale University |
| issn | 1540-8183 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-b6221b32ff4a4be3938c51b75cc0e06a2025-02-03T06:00:27ZengWileyJournal of Interventional Cardiology1540-81832022-01-01202210.1155/2022/5688026Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic StenosisSumit Sohal0Harsh Mehta1Krishna Kurpad2Sheetal Vasundara Mathai3Rajiv Tayal4Gautam K. Visveswaran5Najam Wasty6Sergio Waxman7Marc Cohen8Division of Cardiovascular DiseasesDivision of Cardiovascular DiseasesDepartment of MedicineDepartment of MedicineDivision of Cardiovascular DiseasesDivision of Cardiovascular DiseasesDivision of Cardiovascular DiseasesDivision of Cardiovascular DiseasesDivision of Cardiovascular DiseasesIntroduction. The last decade has witnessed major evolution and shifts in the use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Included among the shifts has been the advent of alternative access sites for TAVR. Consequently, transapical access (TA) has become significantly less common. This study analyzes in detail the trend of TA access for TAVR over the course of 7 years. Methods. The national inpatient sample database was reviewed from 2011–2017 and patients with AS were identified by using validated ICD 9-CM and ICD 10-CM codes. Patients who underwent TAVR through TA access were classified as TA-TAVR, and any procedure other than TA access was classified as non-TA-TAVR. We compared the yearly trends of TA-TAVR to those of non-TA-TAVR as the primary outcome. Results. A total of 3,693,231 patients were identified with a diagnosis of AS. 129,821 patients underwent TAVR, of which 10,158 (7.8%) underwent TA-TAVR and 119,663 (92.2%) underwent non-TA-TAVR. After peaking in 2013 at 27.7%, the volume of TA-TAVR declined to 1.92% in 2017 (p<0.0001). Non-TA-TAVR started in 2013 at 72.2% and consistently increased to 98.1% in 2017. In-patient mortality decreased from a peak of 5.53% in 2014 to 3.18 in 2017 (p=0.6) in the TA-TAVR group and from a peak of 4.51% in 2013 to 1.24% in 2017 (p=0.0001) in the non-TA-TAVR group. Conclusion. This study highlights a steady decline in TA access for TAVR, higher inpatient mortality, increased length of stay, and higher costs compared to non-TA-TAVR.http://dx.doi.org/10.1155/2022/5688026 |
| spellingShingle | Sumit Sohal Harsh Mehta Krishna Kurpad Sheetal Vasundara Mathai Rajiv Tayal Gautam K. Visveswaran Najam Wasty Sergio Waxman Marc Cohen Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis Journal of Interventional Cardiology |
| title | Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis |
| title_full | Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis |
| title_fullStr | Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis |
| title_full_unstemmed | Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis |
| title_short | Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis |
| title_sort | declining trend of transapical access for transcatheter aortic valve replacement in patients with aortic stenosis |
| url | http://dx.doi.org/10.1155/2022/5688026 |
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