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CHANGES IN OUTCOMES OVER TIME IN INTERMEDIATE-RISK PATIENTS TREATED FOR SEVERE AORTIC STENOSIS
  • +8
  • Khalil Khalil,
  • Marouane Boukhris,
  • Malek Badreddine,
  • Walid Ben Ali,
  • Louis-Mathieu Stevens,
  • Jean-Bernard Masson,
  • Jeannot Potvin,
  • Jean-François Gobeil,
  • Nicolas Noiseux,
  • Paul Khairy,
  • Jessica Forcillo
Khalil Khalil
Centre de Recherche du CHUM
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Marouane Boukhris
Centre Hospitalier de l'Université de Montréal
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Malek Badreddine
Centre de Recherche du CHUM
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Walid Ben Ali
Montreal Heart Institute
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Louis-Mathieu Stevens
Centre Hospitalier de l'Université de Montréal
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Jean-Bernard Masson
Centre de Recherche du CHUM
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Jeannot Potvin
Centre de Recherche du CHUM
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Jean-François Gobeil
Centre Hospitalier de l'Université de Montréal
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Nicolas Noiseux
Centre Hospitalier de l'Université de Montréal
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Paul Khairy
Montreal Heart Institute
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Jessica Forcillo
Centre Hospitalier de l'Université de Montréal
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Abstract

Background:The advent of TAVR changed the practice for treating patients with severe aortic stenosis. Heart-Teams improved their decision-making process to refer patients to the best and safest treatment. Evidence allowed centers to increase funding and TAVR volume and extend indications to different risk category of patients. This study evaluates the outcomes of intermediate-risk patients treated for severe aortic stenosis in an academic center. Methods:Between 2012 and 2019, 812 patients with aortic stenosis underwent TAVR or SAVR. A propensity score-matching analytic strategy was used to balance groups and adjust for time periods. Outcomes were recorded according to the Society of Thoracic Surgeons Guidelines; primary outcome being 30-day mortality and secondary outcomes being perioperative course and complications. Results:No difference in mortality was seen but complications differed: more postoperative transient ischemic attacks, permanent pacemaker implantations and perivalvular leaks in the transcatheter group, while more acute kidney injuries, atrial fibrillation, delirium, postoperative infections and bleeding, tamponade and need for reoperation in the surgical group as well as longer hospital length-of-stay. However, over the years, morbidities/mortality decreased for all patients treated for aortic stenosis. Conclusions:Data showed an improvement in morbidities/mortality for intermediate risk patients treated with SAVR or TAVR. Increased funding allowed for higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare cost. By incorporating important metrics such as length-of-stay, readmission rates and complications into decision-making, the Heart-Team can improve clinical outcomes, healthcare economics and resource utilization.

Peer review status:ACCEPTED

17 Aug 2020Submitted to Journal of Cardiac Surgery
18 Aug 2020Assigned to Editor
18 Aug 2020Submission Checks Completed
18 Aug 2020Reviewer(s) Assigned
02 Sep 2020Review(s) Completed, Editorial Evaluation Pending
02 Sep 2020Editorial Decision: Accept