Epidemiology of fatal ruptured aortic aneurysms in the United States (1999-2016).

OBJECTIVE: Ruptured aortic aneurysms (rAAs) are associated with high mortality. The purpose of this study was to describe the trends of deaths due to rAA in the United States. METHODS: A retrospective review of the national death certificate data from the U.S. National Vital Statistics System was done to identify deaths due to rAAs in the United States between 1999 and 2016. Patients aged 15 years or older with rAA as the underlying cause of death as defined by International Classification of Diseases, Tenth Revision codes I71.1 (ruptured thoracic aortic aneurysm [rTAA]), I71.3 (ruptured abdominal aortic aneurysm [rAAA]), I71.5 (ruptured thoracoabdominal aortic aneurysm), and I71.8 (rAA of unspecified site) were included and standardized to U.S. Census data. RESULTS: A total of 104,458 deaths due to rAAs occurred during the study period. The overall age-adjusted incidence of fatal rAA was 23.3 per 1 million (rAAA, 15.1; rTAA, 3.1; thoracoabdominal, 0.4; and unspecified site, 4.8). The annual incidence of rAA decreased by 68% from 40.0 (1999) to 12.8 (2016) per 1 million (rTAA by -67% from 5.5 to 1.8 and rAAA by -70% from 26.3 to 7.89 per 1 million; P < .001 for all comparisons). These trends were consistent across age groups, sexes, and races. There was a significant seasonal variation in rAA mortality, with higher deaths in winter months compared with summer months. The incidence of rAA is highest in Midwest states (27.1 per 1 million), followed by Northeast (23.8 per 1 million) and West (14 per 1 million) states, and lowest in Southern states (13.6 per 1 million). Only 57% of rAAA deaths occurred in men ≥65 years. CONCLUSIONS: The incidence of fatal rAA, rTAA, and rAAA drastically decreased in the United States between 1999 and 2016, a trend that was consistent across age groups, sexes, and races. A significant percentage of fatal rAAAs occurred in patients who are not eligible for the current screening program.

Incidence of Early Atrial Fibrillation After Transcatheter versus Surgical Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Post-operative atrial fibrillation (POAF) is common after aortic valve replacement (AVR) and is associated with worse outcomes. We performed a meta-analysis of randomized controlled trials comparing Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) for incidence of POAF at 30 days. METHODS: We searched databases from 1/1/1990 to 1/1/2020 for randomized studies comparing TAVR and SAVR. POAF was defined as either worsening or new-onset atrial fibrillation. Random effects model was used to estimate the risk of POAF with TAVR vs SAVR in all trials, and in subgroups (low, intermediate, high risk, and in self-expandable vs balloon expandable valves). Sensitivity analysis was performed including only studies reporting new-onset atrial fibrillation. RESULTS: Seven RCTs were identified that enrolled 7,934 patients (3,999 to TAVR and 3,935 to SAVR). The overall incidence of POAF was 9.7% after TAVR and 33.3% after SAVR. TAVR was associated with a lower risk of POAF compared with SAVR (OR 0.21 [0.18-0.24]; P < 0.0001). Compared with SAVR, TAVR was associated with a significantly lower risk of POAF in the high-risk cohort (OR 0.37 [0.27-0.49]; P < 0.0001), in the intermediate-risk cohort (OR 0.23 [0.19-0.28]; P < 0.0001), low-risk cohort (OR 0.13 [0.10-0.16]; P < 0.0001). Sensitivity analysis of 4 trials including only new-onset POAF showed similar summary estimates (OR 0.21, 95% CI [0.18-0.25]; P< 0.0001). CONCLUSIONS: TAVR is associated with a significantly lower risk of post-operative atrial fibrillation compared with SAVR in all strata. Further studies are needed to identify the contribution of post-operative atrial fibrillation to the differences in clinical outcomes after TAVR and SAVR.