Original article
Adult cardiac
Trends in Aortic Valve Replacement Procedures Between 2009 and 2015: Has Transcatheter Aortic Valve Replacement Made a Difference?

Presented at the Poster Session of the Fifty-third Annual Meeting of The Society of Thoracic Surgeons, Houston, TX, Jan 21–25, 2017.
https://doi.org/10.1016/j.athoracsur.2017.10.057Get rights and content

Background

This study reports trends in volume and adverse events associated with isolated aortic valve procedures performed in Medicare beneficiaries between 2009 and 2015.

Methods

This retrospective study used the annual fiscal year Medicare Provider Analysis and Review file to identify all Medicare beneficiaries undergoing an isolated aortic valve procedure. Outcome measures included three mortality rates and nine in-hospital adverse events. The final study population consisted of 233,660 hospitalizations.

Results

During the study period, Medicare beneficiaries undergoing an aortic valve procedure increased from 22,076 to 49,362, for an average annual growth rate of 14.45%. Transcatheter aortic valve replacement (TAVR) procedures per 100,000 Medicare beneficiaries grew from 10.7 in 2012 to 41.1 in 2015. Overall, in-hospital mortality rates, cumulative 30-day mortality rates, and 90-day postdischarge mortality rates declined annually during the study period. However, the 90-day mortality rate for TAVR was nearly double the rate for the tissue surgical aortic valve replacement group. Nearly 68% of Medicare beneficiaries experienced at least one in-hospital adverse event during their index hospitalization. Medicare beneficiaries undergoing TAVR had the lowest observed adverse events rates among the aortic valve procedures in 2015.

Conclusions

The total number of Medicare beneficiaries undergoing isolated aortic valve procedures increased from 47.5 to 88.9 per 100,000 Medicare beneficiaries during the study period. Aortic valve procedures increased significantly during this study period primarily due to the increase in TAVR, with clinical outcomes improving as well. Although long-term outcomes of TAVR are still under investigation, these results are promising.

Section snippets

Patients and Methods

This retrospective study used the annual FY (October 1 to September 30) version of the administrative data sets, Medicare Provider Analysis and Review (MedPAR) files, from 2009 to 2015. The MedPAR file, maintained by the Centers for Medicare and Medicaid Services (CMS), contains all inpatient claims submitted by hospitals without patient identifiers. For each hospitalization, the MedPAR record includes selected patient information, International Classification of Diseases, 9th Edition, Clinical

Results

The number of MBs undergoing isolated aortic valve procedures increased annually from 22,076 in FY-2009 to 49,362 in FY-2015; a compounded average growth rate of 14.4% (Table 1). In addition, the numbers of aortic valve procedures performed per 100,000 MBs increased annually from 47.5 to 88.9. The incidence rate of MBs undergoing only SAVR peaked at 54.0 per 100,000 MBs in FY-2011 before falling to approximately 47.6 per 100,000 MBs by FY-2015. Separately, the number of MBs undergoing TAVR

Comment

This study documents two major volume trends among MBs undergoing isolated aortic valve procedures. First, we identified a 61.2% compounded annual growth in the number of MBs undergoing TAVR between FY-2012 and FY-2015. During FY-2015, MBs undergoing TAVR accounted for 46.2% of all isolated aortic valve procedures in the Medicare population. Second, the number of MBs undergoing SAVR with tissue or mechanical valves grew at a 3.1% compounded annual growth rate during the study period. Although

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