Garg, Lohit, MD

Kansara, Pranav, MD

Kobilja, Boris

Patel, Nainesh C, MD

Patel, Ria

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationRetrospective Study on Clinical OutcomesFollowingTranscatheter Aortic Valve ReplacementBoris KobiljaRia PatelLohit Garg MDLehigh Valley Health Network, lohit.garg@lvhn.orgNainesh C. Patel MDLehigh Valley Health Network, nainesh_c.patel@lvhn.orgPranav Kansara MDLehigh Valley Health Network, Pranav.Kansara@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKobilja, B., Patel, R., Garg, L., Patel, N.,Kansara, P., (2018, August, 3) Retrospective Study on Clinical Outcomes FollowingTranscatheterAortic Valve Replacement. Poster presented at LVHN Research Scholar Poster session, Lehigh Valley Health Network, Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• Heart disease is the leading cause of death in the U.S. with aortic stenosis (AS) being present in 1.5 million Americans, and severe symptomatic AS affecting 250,000 Americans1.• Transcatheter Aortic Valve Replacement (TAVR) surgery is a minimally invasive procedure which replaces the aortic valve in the heart using a porcine valve attached to a catheter2.• TAVR is the preferred procedure for patients suffering from aortic stenosis who are high risk patients for surgical aortic valve replacement (SAVR)3,4.Year 2012 2013 2014 2015 2016 2017Total Patients 13 71 83 105 173 134 5791 Year Mortality2 9 9 11 21 12 64Relative Frequency15.38% 12.68% 10.84% 10.48% 12.14% 8.96% 11.05%• Patients who underwent the TAVR procedure at LVHN had a year mortality of 11.05% (CI 95%, 8.50%-13.60%).• 8.29% (CI 95%, 6.04%-10.54%) of patients experienced procedural complications.• New onset stroke and (LBBB) were present in 3.80% (95% CI, 2.24%-5.36%) and 12.95% (95% CI, 10.22%-15.68%) of all patients.• The relative frequency of patients that experienced procedural complications and then died within one year of TAVR was significantly higher than for patients that died within one year, but did not experience complications (p < 0.05).This study analyzes 1-year mortality as well as clinical outcomes and procedural complications of patients who underwent TAVR surgery in the Lehigh Valley Health Network between 2012-2017. • LVHN 1-year mortality frequencies were significantly lower than published values5.• Stroke and LBBB rates at discharge are comparable to published values5,6.• Procedural complications for patients during TAVR are associated with an increased risk of dying within one year.Background• Objectives• Outcomes • Results• ConclusionsRETROSPECTIVE STUDY ON CLINICAL OUTCOMES FOLLOWING TRANSCATHETERAORTIC VALVE REPLACEMENTBoris Kobilja; Ria Patel; Lohit Garg, MD; Nainesh C. Patel, MD; Pranav P. Kansara, MD• Methods• A retrospective review of all TAVR patients was recorded from 2012-2017 at the Lehigh Valley Health Network. •This study included 624 patients. Using the EPIC database, electronic hospital records of all patients were reviewed and organized into an Excel file.• The variables that were tested included 7 procedural complications, 2 common outcomes present at discharge, and 1-year mortality rates.• Due to lack of patient information available on Epic, only 579 patients were used in the final analysis.Figure 1: 1-year mortality frequencies of patients following TAVR procedure between 2012-2017 at Lehigh Valley Health Network (LVHN). 1-year mortality frequencies are not statistically different between 2012-2017 (p < .05). LVHN 1-year mortality following TAVR was estimated at 11.05% (CI 95%, 8.50%-13.60%), while national published values indicate a 23.7% 1-year mortality5. LVHN mortality is significantly lower than published values (p > 0.05). 52%17%4%11%6%2%8%Vascular Complication RequiringAngioplasty/StentVascular Complication Requiring SurgeryBleeding Requiring TransfusionPericardial Effusion RequiringPericardiocentesisUrgent BypassDevice ComplicationAnnular InjuryFigure 2: Relative distribution of procedural complications (n = 48) during TAVR. 8.29% (CI 95%, 6.04%-10.54%) of patients who underwent TAVR experienced complications, with 52% of those patients specifically having vascular complications that requiredangioplasty/stent.3.80% 4.10%12.95% 11.80%0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%LVHN Holmes DR Jr., et. al. LVHN Roten, Laurent, et. al.Relative Frequency (%)StrokeNew LBBBFigure 3: Indication of stroke and left bundle branch block (LBBB) at discharge. Comparisons of relative frequencies for both outcomes between LVHN and published values5,6. There is no statistical difference between LVHN and published values for either new onset stroke or LBBB at discharge (p > 0.05). 1. Hu PP. TAVR and SAVR: Current Treatment of Aortic Stenosis. Clinical Medicine Insights Cardiology. 2012;6:125-139. doi:10.4137/CMC.S7540.2. “Aortic Valve Stenosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Mar. 2018, www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-203531393. Iivanainen A, Lindroos M, Tilvis R, et al. Natural History of Aortic Valve Stenosis of Varying Severity in the Elderly. Am J Cardiol. 1996:97-101.4. Bach D, Radeva J, Birnbaum H, et al. Prevalence, Referral Patterns, Testing, and Surgery in Aortic Valve Disease: Leaving Women and Elderly Patients Behind. J Heart Valve Disease. 2007:362-9.5. Holmes DR Jr, Brennan JM, Rumsfeld JS, Dai D, O'Brien SM, Vemulapalli S, Edwards FH, Carroll J, Shahian D, Grover F, TuzcuEM, Peterson ED, Brindis RG, Mack MJ; Registry SAT. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. 2015;313:1019–1028.6. Roten, Laurent, and Meier, Bernhard; Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. JACC: Cardiovascular Interventions Feb 2014, 7 (2) 137-139; DOI:10.1016/j.jcin.2013.11.006References31.25%9.23%22.73%10.59%16.00%10.32%0.00%5.00%10.00%15.00%20.00%25.00%30.00%35.00%Complicationsand 1 YearMortalityNoComplicationsand 1 YearMortalityStroke atDischarge and 1Year MortalityNo Stroke atDischarge and 1Year MortalityNew LBBB and 1Year MortalityNo New LBBBand 1 YearMortalityRelative Frequency (%)Figure 5: Relative frequencies of 1-year mortalities for patients that either experienced a certain outcome/complication and for those that did not. Complications, stroke at discharge, and new onset LBBB were all evaluated for 1-year mortality. Only patients who experience procedural complications had a significantly higher 1-year mortality from patients that did not experience complications (p < 0.05).

Retrospective Study on Clinical Outcomes FollowingTranscatheter Aortic Valve Replacement

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1551&context=research-scholars-posters

Retrospective Study on Clinical Outcomes FollowingTranscatheter Aortic Valve Replacement

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