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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities
Jacob M Tupa1, Hunter T Row1, Greta C Schwartz1
1School of Medicine and Health Sciences, University of North Dakota, Fargo and Grand Forks, ND, USA.
The American Surgeon
|November 12, 2024
Summary
Transcatheter aortic valve replacement (TAVR) wait times increased with distance and social vulnerability, but did not impact medium-term survival. Long-term survival decreased with longer waits, though timely care is achievable.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe aortic stenosis (AS).
- Existing research has not clarified potential disparities in TAVR access or outcomes for rural or socially vulnerable populations.
- This study investigates if geographic location and patient vulnerability influence TAVR outcomes.
Purpose of the Study:
- To assess the impact of geographic distance and Social Vulnerability Index (SVI) on TAVR procedural timing.
- To evaluate the association between wait times and TAVR patient outcomes, including survival.
Main Methods:
- A retrospective analysis of 1565 patients undergoing TAVR from August 2012 to June 2023.
- Patient zip codes were used to determine SVI and measure distance to the medical facility.
- Outcomes (stroke, TIA/delirium, pacemaker implantation, new atrial fibrillation/flutter, MI) and survival probability were assessed using Valve Academic Research Consortium 3 (VARC-3) criteria and Kaplan-Meier curves.
Main Results:
- Patients residing further from the facility experienced approximately 9 days longer wait times between coronary angiography (CATH) and TAVR.
- Average wait times between CATH and TAVR were 71 days for low SVI and 78 days for high SVI patients.
- Wait times between computed tomography angiography (CTA) and TAVR were similar for low (40 days) and high (39 days) SVI groups.
Conclusions:
- Increased travel distance correlates with longer pre-TAVR wait times.
- Extended delays between CATH and TAVR were linked to reduced long-term survival but not medium-term survival.
- Despite potential geographic and socioeconomic barriers, TAVR patients can receive timely care with comparable outcomes.
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