ABSTRACT
The objective of this study is based on the phase of care mortality analysis (POCMA), an effective tool to evaluate the root cause of in-hospital mortality in cardiac surgery patients. POCMA has not been used to compare operative mortalities among transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) populations, and may provide insight that could affect patient safety initiatives and improve outcomes in aortic valve surgery. We included patients who underwent TAVR or isolated SAVR between 2011 and March 31, 2015 and did not survive the index hospitalization. A multidisciplinary heart team made POCMA assignments as part of the weekly morbidity and mortality conference, pinpointing the phase of care and subcategory that directly caused or had the greatest effect on each mortality. During the study period, 240 patients underwent TAVR and 530 underwent SAVR. Unadjusted mortality rates were significantly higher in the TAVR group, 5.0% (n = 12) compared with SAVR, 1.9% (n = 10) (P = 0.016). TAVR deaths by phase of care are as follows: 0 for preoperative, 9 (72.8%) for intraoperative, 2 (18.2%) for postoperative intensive care unit, and 1 (9.1%) for postoperative floor. By comparison, 4 (40%) SAVR deaths had a root cause in the preoperative phase, 1 (10%) in the intraoperative phase, and 5 (50%) in the postoperative intensive care unit phase. POCMA is a novel method of categorizing in-hospital mortalities. Our single institution review revealed that patients who underwent TAVR more often expired because of intraoperative technical issues, whereas SAVR deaths were typically the result of patient selection or postoperative complications.
Subject(s)
Aortic Valve Stenosis/therapy , Aortic Valve/surgery , Cardiac Catheterization/mortality , Heart Valve Prosthesis Implantation/mortality , Hospital Mortality , Aged , Aged, 80 and over , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Baltimore , Cardiac Catheterization/adverse effects , Cardiac Catheterization/methods , Cause of Death , Critical Care , Databases, Factual , Female , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Humans , Intraoperative Care , Male , Patient Selection , Postoperative Care , Postoperative Complications/mortality , Preoperative Care , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Cardiac Output, Low/diagnostic imaging , Cardiac Output, Low/drug therapy , Echocardiography , Guideline Adherence , Reminder Systems , Aged , Cardiac Output, Low/mortality , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Humans , Male , Middle Aged , Practice Guidelines as Topic , Stroke Volume , Survival Rate , Treatment OutcomeABSTRACT
One of the more common regular supraventricular tachyarrhythmias encountered in clinical practice is atrioventricular nodal re-entrant tachycardia (AVNRT). Catheter-based radiofrequency ablation is becoming a common modality for the treatment of symptomatic tachyarrhythmias. It is safe and effective, but complications can occur. We present a patient with asymptomatic acute inferior ST elevation myocardial infarction from thermal injury following radiofrequency modification of the slow pathway for the treatment of AVNRT. This case illustrates an unusual mechanism leading to acute myocardial infarction as a complication of a commonly performed electrophysiology procedure that should be recognized by both interventionalists and electrophysiologists and treated aggressively with percutaneous revascularization.
