Morbidity and Mortality Associated with Balloon Aortic Valvuloplasty: A National Perspective

Mohamad Alkhouli, Chad J. Zack, Mohammad Sarraf, Riyaz Bashir, Rick A. Nishimura, Mackram F. Eleid, Vuyisile T. Nkomo, Gurpreet S. Sandhu, Rajiv Gulati, Kevin L. Greason, David R. Holmes, Charanjit S. Rihal

Research output: Contribution to journalArticle

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Abstract

Background - The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes. Methods and Results - The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19-8.61; P<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25-5.36; P<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51-3.18; P<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06-2.37; P=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%; P=0.60), clinical stroke (1.6% versus 3.1%; P=0.10), and vascular complications (8.2% versus 10.9%; P=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%; P<0.001) and blood transfusion (12.8% versus 22.9%; P<0.001). Conclusions - In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.

Original languageEnglish (US)
Article numbere004481
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number5
DOIs
StatePublished - May 1 2017

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Balloon Valvuloplasty
Morbidity
Mortality
Hospital Mortality
Odds Ratio
Confidence Intervals
Blood Transfusion
Blood Vessels
Stroke
Heart-Assist Devices
Cardiogenic Shock
Registries
Inpatients

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Alkhouli, Mohamad ; Zack, Chad J. ; Sarraf, Mohammad ; Bashir, Riyaz ; Nishimura, Rick A. ; Eleid, Mackram F. ; Nkomo, Vuyisile T. ; Sandhu, Gurpreet S. ; Gulati, Rajiv ; Greason, Kevin L. ; Holmes, David R. ; Rihal, Charanjit S. / Morbidity and Mortality Associated with Balloon Aortic Valvuloplasty : A National Perspective. In: Circulation: Cardiovascular Interventions. 2017 ; Vol. 10, No. 5.
@article{2610fc28bf6a436f831e9e627797290e,
title = "Morbidity and Mortality Associated with Balloon Aortic Valvuloplasty: A National Perspective",
abstract = "Background - The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes. Methods and Results - The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4{\%} and 8.5{\%}, respectively. Vascular complications occurred in 7.0{\%} of cases, blood transfusion in 17.5{\%}, clinical stroke in 1.8{\%}, and pacemaker implantation in 3.0{\%}. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95{\%} confidence interval, 4.19-8.61; P<0.001), need for left ventricular assist device (odds ratio, 3.48; 95{\%} confidence interval, 2.25-5.36; P<0.001), coagulopathy (odds ratio, 2.19; 95{\%} confidence interval, 1.51-3.18; P<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95{\%} confidence interval, 1.06-2.37; P=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9{\%} versus 3.5{\%}; P=0.60), clinical stroke (1.6{\%} versus 3.1{\%}; P=0.10), and vascular complications (8.2{\%} versus 10.9{\%}; P=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9{\%} versus 8.0{\%}; P<0.001) and blood transfusion (12.8{\%} versus 22.9{\%}; P<0.001). Conclusions - In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.",
author = "Mohamad Alkhouli and Zack, {Chad J.} and Mohammad Sarraf and Riyaz Bashir and Nishimura, {Rick A.} and Eleid, {Mackram F.} and Nkomo, {Vuyisile T.} and Sandhu, {Gurpreet S.} and Rajiv Gulati and Greason, {Kevin L.} and Holmes, {David R.} and Rihal, {Charanjit S.}",
year = "2017",
month = "5",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.116.004481",
language = "English (US)",
volume = "10",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
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}

Alkhouli, M, Zack, CJ, Sarraf, M, Bashir, R, Nishimura, RA, Eleid, MF, Nkomo, VT, Sandhu, GS, Gulati, R, Greason, KL, Holmes, DR & Rihal, CS 2017, 'Morbidity and Mortality Associated with Balloon Aortic Valvuloplasty: A National Perspective', Circulation: Cardiovascular Interventions, vol. 10, no. 5, e004481. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004481

Morbidity and Mortality Associated with Balloon Aortic Valvuloplasty : A National Perspective. / Alkhouli, Mohamad; Zack, Chad J.; Sarraf, Mohammad; Bashir, Riyaz; Nishimura, Rick A.; Eleid, Mackram F.; Nkomo, Vuyisile T.; Sandhu, Gurpreet S.; Gulati, Rajiv; Greason, Kevin L.; Holmes, David R.; Rihal, Charanjit S.

In: Circulation: Cardiovascular Interventions, Vol. 10, No. 5, e004481, 01.05.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Morbidity and Mortality Associated with Balloon Aortic Valvuloplasty

T2 - A National Perspective

AU - Alkhouli, Mohamad

AU - Zack, Chad J.

AU - Sarraf, Mohammad

AU - Bashir, Riyaz

AU - Nishimura, Rick A.

AU - Eleid, Mackram F.

AU - Nkomo, Vuyisile T.

AU - Sandhu, Gurpreet S.

AU - Gulati, Rajiv

AU - Greason, Kevin L.

AU - Holmes, David R.

AU - Rihal, Charanjit S.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background - The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes. Methods and Results - The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19-8.61; P<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25-5.36; P<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51-3.18; P<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06-2.37; P=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%; P=0.60), clinical stroke (1.6% versus 3.1%; P=0.10), and vascular complications (8.2% versus 10.9%; P=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%; P<0.001) and blood transfusion (12.8% versus 22.9%; P<0.001). Conclusions - In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.

AB - Background - The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes. Methods and Results - The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19-8.61; P<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25-5.36; P<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51-3.18; P<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06-2.37; P=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%; P=0.60), clinical stroke (1.6% versus 3.1%; P=0.10), and vascular complications (8.2% versus 10.9%; P=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%; P<0.001) and blood transfusion (12.8% versus 22.9%; P<0.001). Conclusions - In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.

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