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Related Concept Videos

The Evidence for Evolution02:55

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Genetic variations accumulating within populations over generations give rise to biological evolution. Evolutionary changes can result in the formation of novel varieties and entire new species. These changes are responsible for the diverse forms of life inhabiting the planet. The evidence for evolution suggests that all living organisms descended from common ancestors.
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The endosymbiont theory is the most widely accepted theory of eukaryotic evolution; however, its progression is still somewhat debated. According to the nucleus-first hypothesis, the ancestral prokaryote first evolved a membrane to enclose DNA and form the nucleus. Conversely, the mitochondria-first hypothesis suggests that the nucleus was formed after endosymbiosis of mitochondria.
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Evolution of Veterans Affairs Transcatheter Aortic Valve Replacement Program: The First 100 Patients.

Joseph Yang1, Jeffrey M Zimmet1, Vimala M Ponna2

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Transcatheter aortic valve replacement (TAVR) in the VA system shows excellent outcomes. This study of 100 patients demonstrates successful TAVR program evolution with high survival rates and low complication rates.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Transcatheter aortic valve replacement (TAVR) is a standard treatment for intermediate- and high-risk patients with aortic stenosis.
  • Limited data exist on TAVR outcomes within the Veterans Affairs (VA) system, particularly at federal institutions.
  • This study addresses the need for transparency in VA TAVR program outcomes.

Purpose of the Study:

  • To demonstrate the evolution and outcomes of a successful TAVR program at the San Francisco VA Medical Center.
  • To evaluate mortality and major complications in the first 100 TAVR patients within the VA system.

Main Methods:

  • Retrospective analysis of the first 100 TAVR procedures performed at the San Francisco VA Medical Center.
  • Evaluation of patient demographics, procedural approaches, valve systems used, device success, and complication rates.
  • Assessment of short-term and long-term survival rates.

Main Results:

  • A total of 100 TAVR procedures were performed between November 2013 and August 2016.
  • Overall device success was 96%, with 1% all-cause procedural mortality.
  • Key complications included stroke (2%), vascular injuries (4%), and permanent pacemaker implantation (14%); 1-year survival was 89%.

Conclusions:

  • The VA TAVR program achieved successful outcomes comparable to national benchmarks.
  • These findings highlight favorable TAVR results at a federal institution, enhancing transparency.
  • The study demonstrates the feasibility and effectiveness of TAVR within the VA healthcare system.