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Rapid Adoption of Transcatheter Aortic Valve Replacement in Florida Did Not Diminish Open Volumes

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Transcatheter Aortic Valve Replacement (TAVR) was initially introduced for inoperable or high risk patients (Society of Thoracic Surgeons, STS, Predicted Risk of Mortality (PROM) score of 8% or higher). We analyzed trends of TAVR utilization following introduction and open surgical aortic valve replacement (SAVR) volumes within the state of Florida.


•Analyze whether adoption of TAVR had an effect on the SAVR volumes at hospitals in the state of Florida.
•Compare mortality rates of patients receiving the two procedures. 
Data Collection
Florida Agency for Health Care Administration (AHCA) database
-All patients with primary ICD9 procedure codes between 2009-2014
-SAVR: 35.21, 35.22
-TAVR: 35.05, 35.06
-Annual utilization trends for TAVR and SAVR at the state and hospital level were analyzed including demographics, comorbidities and hospital mortality.
-Comparison of means between the two groups evaluated using t test.
Summary of Results
•TAVR annual volume rose rapidly: 47 (2011) to 1,206 (2014)
•SAVR annual volume decreased only slightly over the study period
•61 hospitals performed TAVR:
        36 performing <10
        17 performing > 50
•TAVR patients were older than SAVR patients
        82 +/­ 9 years versus 70 +/­ 13 years (p<0.001)
• TAVR patients had more comorbidities than SAVR patients
        COPD 37% versus 25% (p<0.001)
        Renal failure 33% versus 18% (p<0.001)
•TAVR hospital mortality did not change significantly (4.6%)
•SAVR hospital mortality significantly decreased from 5.1% 2009 to 3.7% (2014),  p=0.02 
Transcatheter aortic valve replacement has been rapidly adopted within the state of Florida, however, SAVR annual volume have remained approximately 4 fold higher than TAVR.
SAVR hospital mortality decreased significantly during the study period, likely due to higher risk patients receiving TAVR.
While surgical skills for SAVR remain important, cardiothoracic surgeons should continue to pursue endovascular training as TAVR is being rapidly adopted  for  elderly frail patients with comorbidities.
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