Abstract 10788: Temporal Trends in the Utilization of Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis from 2000-2017: Insights from a Multi-Centered Study

HomeCirculationAbstract 10788: Temporal Trends in the Utilization of Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis from 2000-2017: Insights from a Multi-Centered Study Free AccessAbstractAboutSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractInterventional TreatmentsSession Title: Trends and Outcomes of TAVR in Aortic StenosisAbstract 10788: Temporal Trends in the Utilization of Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis from 2000-2017: Insights from a Multi-Centered Study Shawn X Li, Nilay K Patel, Laura Flannery, Alexandra Selberg, Ritvik R Kandanelly, Fritha J Morrison, Varsha K Tanguturi, Daniela R Crousillat, Ayman Shaqdan, Ignacio Inglessis, Pinak B Shah, Jonathan Passeri, Tsuyoshi Kaneko, Arminder Jassar, Nathaniel Langer, Alexander Turchin and Sammy Elmariah Shawn X LiShawn X Li Massachusetts General Hosp, Boston, MA Search for more papers by this author , Nilay K PatelNilay K Patel Massachusetts General Hosp, Boston, MA Search for more papers by this author , Laura FlanneryLaura Flannery Massachusetts General Hosp, Boston, MA Search for more papers by this author , Alexandra SelbergAlexandra Selberg Massachusetts General Hosp, Boston, MA Search for more papers by this author , Ritvik R KandanellyRitvik R Kandanelly Massachusetts General Hosp, Boston, MA Search for more papers by this author , Fritha J MorrisonFritha J Morrison Brigham and Women's Hosp, Boston, MA Search for more papers by this author , Varsha K TanguturiVarsha K Tanguturi Massachusetts General Hosp, Boston, MA Search for more papers by this author , Daniela R CrousillatDaniela R Crousillat Massachusetts General Hosp, Boston, MA Search for more papers by this author , Ayman ShaqdanAyman Shaqdan Massachusetts General Hosp, Boston, MA Search for more papers by this author , Ignacio InglessisIgnacio Inglessis Massachusetts General Hosp, Boston, MA Search for more papers by this author , Pinak B ShahPinak B Shah Brigham and Women's Hosp, Boston, MA Search for more papers by this author , Jonathan PasseriJonathan Passeri Massachusetts General Hosp, Boston, MA Search for more papers by this author , Tsuyoshi KanekoTsuyoshi Kaneko Brigham and Women's Hosp, Boston, MA Search for more papers by this author , Arminder JassarArminder Jassar Massachusetts General Hosp,, Boston, MA Search for more papers by this author , Nathaniel LangerNathaniel Langer Massachusetts General Hosp, Boston, MA Search for more papers by this author , Alexander TurchinAlexander Turchin Brigham and Women's Hosp, Boston, MA Search for more papers by this author and Sammy ElmariahSammy Elmariah Massachusetts General Hosp, Boston, MA Search for more papers by this author Originally published8 Nov 2021https://doi.org/10.1161/circ.144.suppl_1.10788Circulation. 2021;144:A10788AbstractIntroduction: Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), studies have suggested that symptomatic severe AS remains undertreated.Hypothesis: The growth in patients with an indication for AVR has outpaced the number of AVRs performed.Methods: We identified patients with severe AS (aortic valve area <1cm2) on transthoracic echocardiograms from 2000-2017 at two large academic medical centers. Natural language processing (NLP) models were developed and validated to identify symptoms consistent with severe AS, and patients were classified based on ACC/AHA clinical guideline indications for AVR. Patients were divided into groups based on mean aortic valve gradient (mAVG≥ 40 or <40mmHg) and left ventricular ejection fraction (LVEF≥50% or <50%). Utilization of AVR (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) in patients with a clinical indication was examined over time, and clinical predictors of AVR were identified via multivariate logistic regression.Results: A total of 10,795 AS patients were included in this analysis, of whom 6,150 (57%) had an indication or potential indication for AVR and 2,976 (48%) received AVR. The frequency of AVR varied by AS subtype (HG-NEF: 69%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, p<0.001). The adoption of TAVI contributed to the growth in AVR volume over time, however there has been a parallel rise in the number of patients with an indication for AVR (Figure). In patients with a class I indication for AVR, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index TTE, and LVEF≥0.5 were independently associated with an increased likelihood of receiving an AVR.Conclusions: Over an 18-year study period, the proportion of patients with an indication for AVR who do not receive AVR has remained significant despite the rapid growth of AVR volumes.Download figureFootnotesAuthor Disclosures: For author disclosure information, please visit the AHA Scientific Sessions 2021 Online Program Planner and search for the abstract title. eLetters(0) eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate. Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page. Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails November 16, 2021Vol 144, Issue Suppl_1 Advertisement Article Information Metrics © 2021 by American Heart Association, Inc.https://doi.org/10.1161/circ.144.suppl_1.10788 Originally publishedNovember 8, 2021 KeywordsAortic stenosisValvular heart diseaseArtificial IntelligenceTranscatheter aortic valve implantationCardiac surgery Advertisement