TY - JOUR
T1 - Transcatheter Aortic Valve Replacement Complication Rates in Teaching Vs Non-Teaching Centers in the United States
AU - Pant, Sadip
AU - Patel, Samir
AU - Golwala, Harsh
AU - Patel, Nilesh
AU - Pandey, Ambarish
AU - Badheka, Apurva
AU - Angihotri, Kanishk
AU - Patel, Nilay
AU - Deshmukh, Abhishek
AU - Flaherty, Michael P.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/2
Y1 - 2016/2
N2 - OBJECTIVE: The objective of our study is to compare transcatheter aortic valve replacement (TAVR) complication rates among teaching vs non-teaching centers in the United States. METHODS: Using National Inpatient Sample (NIS) data, the largest all-payer database of hospital inpatient stay available in the United States, we identified patients (age ≥18 years) who underwent TAVR from January-December 2012. We constructed multivariable models to determine independent predictors (age, sex, race, Charlson's comorbidity index, hospital size, hospital location, and TAVR approach) of TAVR-associated complications. RESULTS: We identified 7405 TAVR procedures performed in the United States in 2012. In all, 88% of TAVRs were performed in teaching centers. There was no difference in mortality following TAVR between teaching and non-teaching centers. In-hospital complication rate was lower in teaching centers vs non-teaching centers (42% vs 50%, respectively; P<.001). In adjusted analysis, hemorrhage requiring transfusion (13.2% vs 20.8%; P<.001), renal complications requiring dialysis (1.2% vs 2.3%; P<.01), respiratory complications (7.5% vs 11%; P<.001), and complications requiring open-heart surgery (2% vs 4.6%; P<.001) were lower in teaching centers vs non-teaching centers. Vascular access-site, pacemaker insertion, pericardial, and neurological complications were similar between teaching and non-teaching centers. CONCLUSION: Institutional design impacts TAVR complications, albeit with no difference in mortality. In general, complication rates are lower in teaching centers compared with non-teaching centers.
AB - OBJECTIVE: The objective of our study is to compare transcatheter aortic valve replacement (TAVR) complication rates among teaching vs non-teaching centers in the United States. METHODS: Using National Inpatient Sample (NIS) data, the largest all-payer database of hospital inpatient stay available in the United States, we identified patients (age ≥18 years) who underwent TAVR from January-December 2012. We constructed multivariable models to determine independent predictors (age, sex, race, Charlson's comorbidity index, hospital size, hospital location, and TAVR approach) of TAVR-associated complications. RESULTS: We identified 7405 TAVR procedures performed in the United States in 2012. In all, 88% of TAVRs were performed in teaching centers. There was no difference in mortality following TAVR between teaching and non-teaching centers. In-hospital complication rate was lower in teaching centers vs non-teaching centers (42% vs 50%, respectively; P<.001). In adjusted analysis, hemorrhage requiring transfusion (13.2% vs 20.8%; P<.001), renal complications requiring dialysis (1.2% vs 2.3%; P<.01), respiratory complications (7.5% vs 11%; P<.001), and complications requiring open-heart surgery (2% vs 4.6%; P<.001) were lower in teaching centers vs non-teaching centers. Vascular access-site, pacemaker insertion, pericardial, and neurological complications were similar between teaching and non-teaching centers. CONCLUSION: Institutional design impacts TAVR complications, albeit with no difference in mortality. In general, complication rates are lower in teaching centers compared with non-teaching centers.
KW - renal complications
KW - transcatheter aortic valve replacement
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M3 - Article
C2 - 26841440
AN - SCOPUS:84957053032
SN - 1042-3931
VL - 28
SP - 67
EP - 70
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 2
ER -