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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Site Variability in Cerebral Embolic Protection for Transcatheter Aortic Valve Implantation and Association With
Aamer Ubaid1, Kevin F Kennedy2, Adnan K Chhatriwalla1,2
1Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA.
Insights
Most US hospitals do not use cerebral embolic protection devices (CEPD) during transcatheter aortic valve implantation (TAVI). Their use showed no significant difference in stroke or death rates, but increased hospitalization costs.
Area of Science:
- Cardiovascular Medicine
- Neurosurgery
- Health Services Research
Background:
- Cerebral embolic protection devices (CEPD) effectiveness in reducing stroke after transcatheter aortic valve implantation (TAVI) is unclear.
- CEPD utilization varies across US hospitals.
Purpose of the Study:
- To analyze hospital-level patterns of CEPD use during TAVI in the US.
- To investigate the association between CEPD use and patient outcomes.
Main Methods:
- Analysis of the 2019 Nationwide Readmissions Database for patients undergoing nontransapical TAVI.
- Hospitals categorized as CEPD non-users or CEPD users.
- Risk-adjusted logistic regression to compare in-hospital stroke/TIA, ischemic stroke, death, and hospitalization costs.
Main Results:
- CEPD were used in 10.6% of 41,822 TAVI encounters across 392 hospitals.
- No significant differences in stroke, TIA, or death rates between CEPD non-user and user hospitals.
- Hospitalization costs were lower in CEPD non-user hospitals.
Conclusions:
- Two-thirds of US hospitals do not use CEPD for TAVI.
- No significant association found between CEPD use and improved neurologic outcomes.
- Current evidence does not support routine CEPD use for TAVI based on observed outcomes and costs.
Background:
The effectiveness of cerebral embolic protection devices (CEPD) in mitigating stroke after transcatheter aortic valve implantation (TAVI) remains uncertain, and therefore CEPD may be utilized differently across US hospitals. This study aims to characterize the hospital-level pattern of CEPD use during TAVI in the US and its association with outcomes.
Methods:
Patients treated with nontransapical TAVI in the 2019 Nationwide Readmissions Database were included. Hospitals were categorized as CEPD non-users and CEPD users. The following outcomes were compared: the composite of in-hospital stroke or transient ischemic attack (TIA), in-hospital ischemic stroke, death, and cost of hospitalization. Logistic regression models were used for risk adjustment of clinical outcomes.
Results:
Of 41,822 TAVI encounters, CEPD was used in 10.6% (n = 4422). Out of 392 hospitals, 65.8% were CEPD non-user hospitals and 34.2% were CEPD users. No difference was observed between CEPD non-users and CEPD users in the risk of in-hospital stroke or TIA (adjusted odds ratio (OR) = 0.99 [0.86-1.15]), ischemic stroke (adjusted OR = 1.00 [0.85-1.18]), or in-hospital death (adjusted OR = 0.86 [0.71-1.03]). The cost of hospitalization was lower in CEPD non-users.
Conclusions:
Two-thirds of hospitals in the US do not use CEPD for TAVI, and no significant difference was observed in neurologic outcomes among patients treated at CEPD non-user and CEPD user hospitals.
