Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers: Insights From the Veterans Affairs Clinical Assessment,Reporting, and Tracking Program |
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| Authors: | Philip S Hall Colin I O’Donnell Verghese Mathew Santiago Garcia Anthony A Bavry Subhash Banerjee Hani Jneid Ali E Denktas John C Giacomini Paul M Grossman Kul Aggarwal Jeffrey M Zimmet Elaine E Tseng Leo Gozdecki Lucas Burke Stefan C Bertog Maurice Buchbinder Mary E Plomondon Kendrick A Shunk |
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| Institution: | 1. University of North Carolina Rex Healthcare, Raleigh, North Carolina;2. University of Colorado and Rocky Mountain Regional VA Medical Center, Aurora, Colorado;3. Loyola University Stritch College of Medicine, Maywod, Illinois;4. University of Minnesota and VA Medical Center, Minneapolis, Minnesota;5. Valve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota;6. University of Florida and VA Medical Center, Gainesville, Florida;7. University of Texas, Southwestern and North Texas VA Medical Center, Dallas, Texas;8. Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas;9. Stanford University and VA Medical Center, Palo Alto, California;10. University of Michigan and VA Medical Center, Ann Arbor, Michigan;11. University of Missouri and Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri;12. University of California and Veterans Affairs Medical Center, San Francisco, California |
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| Abstract: | ObjectivesThis study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days.BackgroundVeterans with severe aortic stenosis frequently undergo TAVR at VA medical centers.MethodsConsecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization.ResultsNine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). Nonfemoral access (odds ratio: 1.74; 95% confidence interval CI]: 1.10 to 2.74), heart failure (odds ratio: 2.51; 95% CI: 1.83 to 3.44), and atrial fibrillation (odds ratio: 1.40; 95% CI: 1.01 to 1.95) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63).ConclusionsVeterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA. |
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| Keywords: | aortic stenosis transcatheter aortic valve replacement veterans AS aortic stenosis CAD coronary artery disease CART Clinical Assessment Reporting and Tracking CI confidence interval FDA U S Food and Drug Administration HF heart failure STS Society of Thoracic Surgeons TAVR transcatheter aortic valve replacement TVT Transcatheter Valve Therapy VA U S Department of Veterans Affairs |
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