Faculty Collaboration Database

Outcomes, readmissions, and costs in transfemoral and alterative access transcatheter aortic valve replacement in the US Medicare population. J Thorac Cardiovasc Surg 2017 Oct;154(4):1224-1232.e1

Date

07/18/2017

Pubmed ID

28712578

DOI

10.1016/j.jtcvs.2017.04.090

Scopus ID

2-s2.0-85023640784 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

OBJECTIVE: To comprehensively evaluate and compare utilization, outcomes, and especially costs of transfemoral (TF), transapical (TA), and transaortic (TAO) transcatheter aortic valve replacement (TAVR).

METHODS: All Medicare fee-for-service patients undergoing TF (n = 4065), TA (n = 691), or TAO (n = 274) TAVR between January 1, 2011, and November 30, 2012, were identified using Health Care Procedure Classification Codes present on Medicare claims. Hospital charges from Medicare claims were converted to costs using hospital-specific Medicare cost-to-charge ratios.

RESULTS: TA and TAO patients were similar in age, race, and common comorbidities. Compared with TF patients, TA and TAO patients were more likely to be female and to have peripheral vascular disease, chronic lung disease, and renal failure. Thirty-day mortality rates were higher among TA and TAO patients than among TF patients (TA, 9.6%; TAO, 8.0%; TF, 5.0%; P < .001). Adjusted mortality beyond 1 year did not differ by access. TA patients were more likely to require cardiopulmonary bypass (CPB). Increased adjusted mortality was associated with CPB (hazard ratio, 2.13; P < .01) and increased 30-day cost ($62,000 [interquartile range (IQR)], $45,100-$86,400 versus $48,800 [IQR, $38,100-$62,900]; P < .01). Cost at 30 days was lowest for TF ($48,600) compared with TA ($49,800; P < .01) and TAO ($53,200; P = .03).

CONCLUSIONS: For patients ineligible to receive TF TAVR, TAO and TA approaches offer similar clinical outcomes at similar cost with acceptable operative and 1-year survival, except for higher rates of CPB use in TA patients. CPB was associated with worse survival and increased costs.

Author List

McCarthy FH, Spragan DD, Savino D, Dibble T, Hoedt AC, McDermott KM, Bavaria JE, Herrmann HC, Anwaruddin S, Giri J, Szeto WY, Groeneveld PW, Desai ND

Author

Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aorta
Aortic Valve Stenosis
Catheterization, Peripheral
Costs and Cost Analysis
Female
Femoral Artery
Humans
Male
Medicare
Retrospective Studies
Risk Assessment
Risk Factors
Survival Analysis
Transcatheter Aortic Valve Replacement
Treatment Outcome
United States