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Rapid Adoption of Transcatheter Aortic Valve Replacement in Florida Did Not Diminish Open Volumes
Lisa M. Soler1, Kalei Walker2, Julie A. Richter1, Anthony A. Bavry1, David R. Anderson1, John W. Petersen1, Charles Klodell1, Calvin Choi1, William B. Smith1, Kent Berg1, Thomas M. Beaver1.
1University of Florida, Gainesville, FL, USA, 2Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

Introduction: Transcatheter aortic valve replacement (TAVR) has been rapidly adopted internationally. We analyzed the TAVR utilization and open surgical aortic valve replacement (SAVR) trends within the state of Florida, which has a large elderly population.
Methods: The Florida Agency for Health Care Administration database was queried from 2009-2014 to identify all patients with primary ICD9 procedure codes for SAVR (35.21, 35.22) and 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.
Results: TAVR annual volume rose rapidly from 47 (2011) to 1,206 (2014), whereas SAVR annual volume decreased only slightly over the 5 year study period (Figure). Increasing number of centers offering TAVR, including several high volume centers, drove this dramatic increase in TAVR volume. From 2011 to 2014, 61 hospitals performed TAVR: 36 were low volume centers, performing fewer than 10 TAVRs during the study period, and 17 were high volume centers, performing greater than 50 TAVRs during the study period. Concordant with guideline indications; TAVR patients were older than SAVR patients, mean age 82 +/- 9 years versus 70 +/- 13 years (p<0.001), and had more comorbidities, COPD 17% versus 6% (p<0.001) and renal failure 17% versus 6% (p<0.001). Hospital mortality for TAVR did not change significantly from 2011-2014 (overall 4.6%). However, SAVR hospital mortality significantly decreased between 2009-2014, from 5.1% to 3.7% (p=0.02).
Conclusion: Transcatheter aortic valve replacement has been rapidly adopted within the state of Florida. This has not dramatically affected SAVR annual volume, which remained approximately 4 fold higher than TAVR. However, SAVR hospital mortality decreased significantly during the study period, likely due to higher risk patients receiving TAVR. While maintaining surgical skill sets required to perform SAVR remains important, with an ever increasing demand for minimally invasive procedures, cardiothoracic surgeons should continue to pursue endovascular training as this skill set will be especially required for treating elderly frail patients with aortic valve pathology.

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