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Appropriateness of Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry.

Publication ,  Journal Article
Inohara, T; Vemulapalli, S; Kohsaka, S; Yashima, F; Watanabe, Y; Shirai, S; Tada, N; Araki, M; Naganuma, T; Yamanaka, F; Ueno, H; Tabata, M ...
Published in: Circ Cardiovasc Qual Outcomes
April 2020

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is widely used; however, its appropriateness is unknown. We sought to investigate the appropriateness of TAVR. METHODS AND RESULTS: We assigned appropriateness ratings to patients undergoing TAVR for severe aortic stenosis between October 2013 and May 2017 at 14 Japanese hospitals participating in the optimized transcatheter valvular intervention-transcatheter aortic valve implantation registry according to the US appropriate use criteria for treating severe aortic stenosis. To account for the influence of uncaptured variables on appropriate use criteria ratings, we initially assigned them to a best-case scenario where they were assumed to classify a case to the most appropriate clinical scenario and then to a worst-case scenario where assumed least appropriate. Overall proportion of TAVRs classified as appropriate, maybe appropriate, or rarely appropriate was assessed. In addition, extent of hospital-level variation in rarely appropriate procedures was evaluated. Of 2036 TAVRs (median age [25th, 75th]: 85.0 years [81.0-88.0]; 70.5% female the Society of Thoracic Surgeons Predicted Risk of Mortality score: 6.2% [4.4-8.9]), in the best-case scenario, 177 (8.7%) were not successfully mapped, and 1580 (77.6%) were classified as appropriate, 180 (8.8%) as maybe appropriate, 99 (4.9%) as rarely appropriate, respectively. In the worst-case scenario, the rate of rarely appropriate increased to 6.8%. The majority of rarely appropriate TAVRs was performed in patients with moderate to severe dementia (defined as mini-mental status examination of ≤17), bicuspid aortic valve, or anticipated life expectancy <1 year. There was substantial variation in the proportion of rarely appropriate TAVR across hospitals (median rate of rarely appropriate: 4.9% [3.8-6.6] in the best-case scenario, P<0.001; 6.5% [5.6-8.6] in the worst-case scenario, P<0.001). CONCLUSIONS: In clinical practice, the proportion of rarely appropriate TAVRs ranged from 4.9% to 6.8% with substantial institutional variation. Our study elucidates common clinical scenarios deemed rarely appropriate and clarifies the potential targets of quality improvement. Registration: URL: https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000020423.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

April 2020

Volume

13

Issue

4

Start / End Page

e006146

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Severity of Illness Index
  • Risk Factors
  • Registries
  • Quality Indicators, Health Care
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Patient Selection
  • Outcome and Process Assessment, Health Care
 

Citation

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Inohara, T., Vemulapalli, S., Kohsaka, S., Yashima, F., Watanabe, Y., Shirai, S., … OCEAN-TAVI Investigators, . (2020). Appropriateness of Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry. Circ Cardiovasc Qual Outcomes, 13(4), e006146. https://doi.org/10.1161/CIRCOUTCOMES.119.006146
Inohara, Taku, Sreekanth Vemulapalli, Shun Kohsaka, Fumiaki Yashima, Yusuke Watanabe, Shinichi Shirai, Norio Tada, et al. “Appropriateness of Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry.Circ Cardiovasc Qual Outcomes 13, no. 4 (April 2020): e006146. https://doi.org/10.1161/CIRCOUTCOMES.119.006146.
Inohara T, Vemulapalli S, Kohsaka S, Yashima F, Watanabe Y, Shirai S, et al. Appropriateness of Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry. Circ Cardiovasc Qual Outcomes. 2020 Apr;13(4):e006146.
Inohara, Taku, et al. “Appropriateness of Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry.Circ Cardiovasc Qual Outcomes, vol. 13, no. 4, Apr. 2020, p. e006146. Pubmed, doi:10.1161/CIRCOUTCOMES.119.006146.
Inohara T, Vemulapalli S, Kohsaka S, Yashima F, Watanabe Y, Shirai S, Tada N, Araki M, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Higashimori A, Takagi K, Yamamoto M, Shimizu H, Fukuda K, Hayashida K, OCEAN-TAVI Investigators. Appropriateness of Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry. Circ Cardiovasc Qual Outcomes. 2020 Apr;13(4):e006146.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

April 2020

Volume

13

Issue

4

Start / End Page

e006146

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Severity of Illness Index
  • Risk Factors
  • Registries
  • Quality Indicators, Health Care
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Patient Selection
  • Outcome and Process Assessment, Health Care