Percutaneous aortic balloon valvotomy in the United States: a 13-year perspective.
Percutaneous aortic balloon valvotomy in the United States: a 13-year perspective.
- 2014
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
BACKGROUND: We determined the contemporary trends of percutaneous aortic balloon valvotomy and its outcomes using the nation's largest hospitalization database. There has been a resurgence in the use of percutaneous aortic balloon valvotomy in patients at high surgical risk because of the development of less-invasive endovascular therapies. CONCLUSION: This study comprehensively evaluates trends for percutaneous aortic balloon valvotomy in the United States and demonstrates the significance of operator and hospital volume on outcomes. Copyright 2014 Elsevier Inc. All rights reserved. METHODS: This is a cross-sectional study with time trends using the Nationwide Inpatient Sample database between the years 1998 and 2010. We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure code for valvotomy. Only patients aged more than 60 years with aortic stenosis were included. Primary outcome included in-hospital mortality, and secondary outcomes included procedural complications and length of hospital stay. RESULTS: A total of 2127 percutaneous aortic balloon valvotomies (weighted n = 10,640) were analyzed. The use rate of percutaneous aortic balloon valvotomy increased by 158% from 12 percutaneous aortic balloon valvotomies per million elderly patients in 1998-1999 to 31 percutaneous aortic balloon valvotomies per million elderly patients in 2009-2010 in the United States (P < .001). The hospital mortality decreased by 23% from 11.5% in 1998-1999 to 8.8% in 2009-2010 (P < .001). Significant predictors of in-hospital mortality were the presence of increasing comorbidities (P = .03), unstable patient (P < .001), any complication (P < .001), and weekend admission (P = .008), whereas increasing operator volume was associated with significantly reduced mortality (P = .03). Patients who were admitted to hospitals with the highest procedure volume and the highest volume operators had a 51% reduced likelihood (P = .05) of in-hospital mortality when compared with those in hospitals with the lowest procedure volume and lowest volume operators.
English
0002-9343
*Balloon Valvuloplasty/mt [Methods]
*Heart Valve Diseases/su [Surgery]
*Percutaneous Coronary Intervention/mt [Methods]
Aged
Aged, 80 and over
Balloon Valvuloplasty/ae [Adverse Effects]
Female
Humans
Male
Odds Ratio
Percutaneous Coronary Intervention/ae [Adverse Effects]
Risk Factors
Time Factors
United States
MedStar Washington Hospital Center
Medicine/General Internal Medicine
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
BACKGROUND: We determined the contemporary trends of percutaneous aortic balloon valvotomy and its outcomes using the nation's largest hospitalization database. There has been a resurgence in the use of percutaneous aortic balloon valvotomy in patients at high surgical risk because of the development of less-invasive endovascular therapies. CONCLUSION: This study comprehensively evaluates trends for percutaneous aortic balloon valvotomy in the United States and demonstrates the significance of operator and hospital volume on outcomes. Copyright 2014 Elsevier Inc. All rights reserved. METHODS: This is a cross-sectional study with time trends using the Nationwide Inpatient Sample database between the years 1998 and 2010. We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure code for valvotomy. Only patients aged more than 60 years with aortic stenosis were included. Primary outcome included in-hospital mortality, and secondary outcomes included procedural complications and length of hospital stay. RESULTS: A total of 2127 percutaneous aortic balloon valvotomies (weighted n = 10,640) were analyzed. The use rate of percutaneous aortic balloon valvotomy increased by 158% from 12 percutaneous aortic balloon valvotomies per million elderly patients in 1998-1999 to 31 percutaneous aortic balloon valvotomies per million elderly patients in 2009-2010 in the United States (P < .001). The hospital mortality decreased by 23% from 11.5% in 1998-1999 to 8.8% in 2009-2010 (P < .001). Significant predictors of in-hospital mortality were the presence of increasing comorbidities (P = .03), unstable patient (P < .001), any complication (P < .001), and weekend admission (P = .008), whereas increasing operator volume was associated with significantly reduced mortality (P = .03). Patients who were admitted to hospitals with the highest procedure volume and the highest volume operators had a 51% reduced likelihood (P = .05) of in-hospital mortality when compared with those in hospitals with the lowest procedure volume and lowest volume operators.
English
0002-9343
*Balloon Valvuloplasty/mt [Methods]
*Heart Valve Diseases/su [Surgery]
*Percutaneous Coronary Intervention/mt [Methods]
Aged
Aged, 80 and over
Balloon Valvuloplasty/ae [Adverse Effects]
Female
Humans
Male
Odds Ratio
Percutaneous Coronary Intervention/ae [Adverse Effects]
Risk Factors
Time Factors
United States
MedStar Washington Hospital Center
Medicine/General Internal Medicine
Journal Article