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Pieter A Kappetein - One of the best experts on this subject based on the ideXlab platform.
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costs of transcatheter versus surgical aortic valve replacement in Intermediate Risk patients
The Annals of Thoracic Surgery, 2012Co-Authors: Ruben L J Osnabrugge, Stuart J Head, Tessa S S Genders, Nicolas M Van Mieghem, Peter De Jaegere, Robert M A Van Der Boon, Marco J Kerkvliet, Bindu Kalesan, Ad J J C Bogers, Pieter A KappeteinAbstract:Background Transcatheter aortic valve replacement (TAVR) offers a new treatment option for patients with aortic stenosis, but costs may play a decisive role in decision making. Current studies are evaluating TAVR in an Intermediate-Risk Population. We assessed the in-hospital and 1-year follow-up costs of patients undergoing TAVR and surgical aortic valve replacement (SAVR) at Intermediate operative Risk and identified important cost components. Methods We prospectively collected clinical data on 141 patients undergoing TAVR and 405 undergoing SAVR. Propensity score matching yielded 42 matched pairs at Intermediate Risk. Costs were assessed using a detailed resource-use approach and compared using bootstrap methods. Results In-hospital costs were higher in TAVR patients than in SAVR patients (€40802 vs €33354, respectively; p = 0.010). The total costs at 1 year were €46217 vs €35511, respectively ( p = 0.009). The TAVR was less costly with regard to blood products, operating room use, and length-of-stay. Conclusions For Intermediate-Risk patients with severe aortic stenosis the costs at 1 year are higher for TAVR than for SAVR. The difference was mainly caused by the higher costs of the transcatheter valve and was not compensated by the lower costs for blood products and hospital stay in TAVR patients. Therefore, SAVR remains a clinically and economically attractive treatment option.
Theodor Fischlein - One of the best experts on this subject based on the ideXlab platform.
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early hemodynamics and clinical outcomes of isolated aortic valve replacement with stentless or transcatheter valve in Intermediate Risk patients
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Alberto Repossini, Lorenzo Di Bacco, Bruno Passaretti, Herko Grubitzsch, Christina Schafer, Benjamin Claus, Laura Giroletti, Thierry Folliguet, Gianluigi Bisleri, Theodor FischleinAbstract:Abstract Objective Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an Intermediate Risk Population undergoing surgical aortic valve replacement. Methods From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with Intermediate operative Risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Results Mean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR ( P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 mm Hg); TAVR peak gradients were 20.2 ± 9.5 mm Hg (mean 10.7 ± 6.9 mm Hg) P = .57 ( P = .88). Postoperative effective orifice area was 1.93 ± 0.52 cm 2 for FS and 1.83 ± 0.3 cm 2 for TAVR ( P = .65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group ( P Conclusions In patients with small aortic annulus and Intermediate Risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients.
Danilo Fusco - One of the best experts on this subject based on the ideXlab platform.
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1 year outcomes after transfemoral transcatheter or surgical aortic valve replacement results from the italian observant study
Journal of the American College of Cardiology, 2015Co-Authors: Corrado Tamburino, Marco Barbanti, Paola Derrigo, Marco Ranucci, Francesco Onorati, Remo Daniel Covello, Francesco Santini, Stefano Rosato, Gennaro Santoro, Danilo FuscoAbstract:Abstract Background There is a paucity of prospective and controlled data on the comparative effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in a real-world setting. Objectives This analysis aims to describe 1-year clinical outcomes of a large series of propensity-matched patients who underwent SAVR and transfemoral TAVR. Methods The OBSERVANT (Observational Study of Effectiveness of SAVR–TAVI Procedures for Severe Aortic Stenosis Treatment) trial is an observational prospective multicenter cohort study that enrolled patients with aortic stenosis (AS) who underwent SAVR or TAVR. The propensity score method was applied to select 2 groups with similar baseline characteristics. All outcomes were adjudicated through a linkage with administrative databases. The primary endpoints of this analysis were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Results The unadjusted enrolled Population (N = 7,618) included 5,707 SAVR patients and 1,911 TAVR patients. The matched Population had a total of 1,300 patients (650 per group). The propensity score method generated a low-Intermediate Risk Population (mean logistic EuroSCORE 1: 10.2 ± 9.2% vs. 9.5 ± 7.1%, SAVR vs. transfemoral TAVR; p = 0.104). At 1 year, the rate of death from any cause was 13.6% in the surgical group and 13.8% in the transcatheter group (hazard ratio [HR]: 0.99; 95% confidence interval [CI]: 0.72 to 1.35; p = 0.936). Similarly, there were no significant differences in the rates of MACCE, which were 17.6% in the surgical group and 18.2% in the transcatheter group (HR: 1.03; 95% CI: 0.78 to 1.36; p = 0.831). The cumulative incidence of cerebrovascular events, and rehospitalization due to cardiac reasons and acute heart failure was similar in both groups at 1 year. Conclusions The results suggest that SAVR and transfemoral TAVR have comparable mortality, MACCE, and rates of rehospitalization due to cardiac reasons at 1 year. These data need to be confirmed in longer term and dedicated ongoing randomized trials.
Ruben L J Osnabrugge - One of the best experts on this subject based on the ideXlab platform.
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costs of transcatheter versus surgical aortic valve replacement in Intermediate Risk patients
The Annals of Thoracic Surgery, 2012Co-Authors: Ruben L J Osnabrugge, Stuart J Head, Tessa S S Genders, Nicolas M Van Mieghem, Peter De Jaegere, Robert M A Van Der Boon, Marco J Kerkvliet, Bindu Kalesan, Ad J J C Bogers, Pieter A KappeteinAbstract:Background Transcatheter aortic valve replacement (TAVR) offers a new treatment option for patients with aortic stenosis, but costs may play a decisive role in decision making. Current studies are evaluating TAVR in an Intermediate-Risk Population. We assessed the in-hospital and 1-year follow-up costs of patients undergoing TAVR and surgical aortic valve replacement (SAVR) at Intermediate operative Risk and identified important cost components. Methods We prospectively collected clinical data on 141 patients undergoing TAVR and 405 undergoing SAVR. Propensity score matching yielded 42 matched pairs at Intermediate Risk. Costs were assessed using a detailed resource-use approach and compared using bootstrap methods. Results In-hospital costs were higher in TAVR patients than in SAVR patients (€40802 vs €33354, respectively; p = 0.010). The total costs at 1 year were €46217 vs €35511, respectively ( p = 0.009). The TAVR was less costly with regard to blood products, operating room use, and length-of-stay. Conclusions For Intermediate-Risk patients with severe aortic stenosis the costs at 1 year are higher for TAVR than for SAVR. The difference was mainly caused by the higher costs of the transcatheter valve and was not compensated by the lower costs for blood products and hospital stay in TAVR patients. Therefore, SAVR remains a clinically and economically attractive treatment option.
Alberto Repossini - One of the best experts on this subject based on the ideXlab platform.
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early hemodynamics and clinical outcomes of isolated aortic valve replacement with stentless or transcatheter valve in Intermediate Risk patients
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Alberto Repossini, Lorenzo Di Bacco, Bruno Passaretti, Herko Grubitzsch, Christina Schafer, Benjamin Claus, Laura Giroletti, Thierry Folliguet, Gianluigi Bisleri, Theodor FischleinAbstract:Abstract Objective Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an Intermediate Risk Population undergoing surgical aortic valve replacement. Methods From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with Intermediate operative Risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Results Mean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR ( P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 mm Hg); TAVR peak gradients were 20.2 ± 9.5 mm Hg (mean 10.7 ± 6.9 mm Hg) P = .57 ( P = .88). Postoperative effective orifice area was 1.93 ± 0.52 cm 2 for FS and 1.83 ± 0.3 cm 2 for TAVR ( P = .65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group ( P Conclusions In patients with small aortic annulus and Intermediate Risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients.