A shifting approach to management of the thoracic aorta in bicuspid aortic valve.

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  • Additional Information
    • Source:
      Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: St. Louis, MO : Mosby
      Original Publication: St. Louis.
    • Subject Terms:
      Aorta, Thoracic/*surgery ; Aortic Aneurysm, Thoracic/*surgery ; Cardiac Surgical Procedures/*trends ; Heart Valve Diseases/*surgery ; Practice Patterns, Physicians'/*trends ; Vascular Surgical Procedures/*trends; Adolescent ; Adult ; Aged ; Aortic Aneurysm, Thoracic/economics ; Aortic Aneurysm, Thoracic/etiology ; Aortic Aneurysm, Thoracic/mortality ; Aortic Valve/abnormalities ; Aortic Valve/surgery ; Bicuspid Aortic Valve Disease ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/economics ; Cardiac Surgical Procedures/mortality ; Databases as Topic ; Dilatation, Pathologic ; Female ; Heart Valve Diseases/complications ; Heart Valve Diseases/economics ; Heart Valve Diseases/mortality ; Heart Valve Prosthesis Implantation/trends ; Hospital Costs/trends ; Humans ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Practice Patterns, Physicians'/economics ; Risk Factors ; Time Factors ; Treatment Outcome ; United States ; Vascular Surgical Procedures/adverse effects ; Vascular Surgical Procedures/economics ; Vascular Surgical Procedures/mortality ; Young Adult
    • Abstract:
      Objectives: The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States.
      Methods: We used the 1998-2009 Nationwide Inpatient Sample, an administrative dataset representative of US hospital admissions, to identify hospitalizations for adults aged 18 years or more with BAV and aortic valve or thoracic aortic surgery. Covariates included age, gender, year, aortic dissection, endocarditis, thoracic aortic aneurysm, number of comorbidities, hospital teaching status and region, primary insurance, and concomitant coronary artery bypass surgery.
      Results: Between 1998 and 2009, 48,736 ± 3555 patients with BAV underwent aortic valve repair or replacement and 1679 ± 120 patients with BAV underwent isolated thoracic aortic surgery. The overall number of surgeries increased more than 3-fold, from 4556 ± 571 in 1998/1999 to 14,960 ± 2107 in 2008/2009 (P < .0001). The proportion of aortic valve repair or replacement including concomitant thoracic aortic surgery increased from 12.8% ± 1.4% in 1998/1999 to 28.5% ± 1.6% in 2008/2009, which mirrored an increasing proportion of patients with a diagnosis of thoracic aortic aneurysm. Mortality was equivalent for patients undergoing aortic valve repair or replacement with thoracic aortic surgery and those undergoing isolated aortic valve repair or replacement (1.8% ± 0.3% vs 1.5% ± 0.2%; multivariable odds ratio, 1.02; 95% confidence interval, 0.67-1.57), with decreasing mortality over the study period (from 2.5% ± 0.6% in 1998/1999 to 1.5% ± 0.2% in 2008/2009; multivariable odds ratio per 2-year increment, 0.89; 95% confidence interval, 0.81-0.99; P = .03). Total charges for BAV surgical hospitalizations increased more than 7.5-fold from approximately $156 million in 1998 to $1.2 billion in 2009 (inflation-adjusted 2009 dollars).
      Conclusions: There was a marked increase in the use of thoracic aortic surgery among patients with BAV.
      (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
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    • Grant Information:
      5 T32 HL07604-25 United States HL NHLBI NIH HHS; R01 HL114823 United States HL NHLBI NIH HHS; UL1 RR025758 United States RR NCRR NIH HHS; UL1 RR 025758 United States RR NCRR NIH HHS; T32 HL007604 United States HL NHLBI NIH HHS
    • Contributed Indexing:
      Keywords: 20.2; 26.1; ACC; AHA; AVR; American College of Cardiology; American Heart Association; BAV; CI; OR; TAA; TAS; aortic valve repair or replacement; bicuspid aortic valve; confidence interval; odds ratio; thoracic aortic aneurysm; thoracic aortic surgery
    • Publication Date:
      Date Created: 20121113 Date Completed: 20130927 Latest Revision: 20211021
    • Publication Date:
      20240829
    • Accession Number:
      PMC4086685
    • Accession Number:
      10.1016/j.jtcvs.2012.10.028
    • Accession Number:
      23142124