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Page 2 of 13 Kolba et al. Vessel Plus 2023;7:12 https://dx.doi.org/10.20517/2574-1209.2022.61

patients, MEI patients had no different risk-adjusted new onset of POAF (AVR P = 0.575; r-AVR P = 0.497),
30-day readmission (AVR P = 0.163; r-AVR P = 0.486), and mortality/morbidity composite (AVR P = 0.848;
r-AVR P = 0.295) rates.

Conclusions: Despite MEI patients’ inherent higher pre-procedural AVR/r-AVR risk, no differences in the MEI vs.
non-MEI risk-adjusted POAF/AFL, 30-day readmission, or composite rates were found; however, MEI patients
more frequently were selected to receive transcatheter rather than open surgical procedures.

Keywords: Aortic stenosis, aortic valve replacement, surgical aortic valve replacement, transcatheter aortic valve
replacement, valve-in-valve, repeat surgical aortic valve replacement, atrial fibrillation, mental illness, depression,
anxiety

INTRODUCTION
[1]
The prevalence of symptomatic aortic stenosis (AS) increases with age . Since 2012, an alternative to
traditional surgical aortic valve replacement (SAVR) is FDA-approved transcatheter aortic valve
replacement (TAVR) . In 2021, the aortic valve replacement (AVR)-related in-hospital mortality rates
[2]
[3,4]
reported for SAVR and TAVR procedures were estimated at 0.7% and 2.2%, respectively .
For a repeated AVR (r-AVR) procedure, in-hospital mortality rates range between 2.3% and 17.6% .
[5]
Reported r-AVR risk factors including female gender, history of coronary artery disease, and lower
creatinine clearance have been found to be independent predictors of early mortality .
[6]

A novel preoperative risk factor that has not yet been well studied, however, is a mental illness diagnosis.
For patients with pre-existing mental illness, moreover, little is known about the utilization of TAVR in this
context and whether the traditional reluctance to offer a SAVR to complex patients has been overcome . To
[7]
address this knowledge gap, the current study utilized the New York State Statewide Planning and Research
Cooperative System (SPARCS) administrative health care encounter-based database to evaluate the impact
[8]
of a preoperative mental illness diagnosis upon AVR and r-AVR patients’ postprocedural outcomes .

METHODS
The New York state’s SPARCS mandatory billing database
With mandatory reporting required since 1979, the New York SPARCS administrative database was used
[8]
for this study . SPARCS represents a comprehensive, all payer, administrative database documenting all
inpatient and outpatient care, ambulatory surgery, and emergency room care provided at New York State’s
non-federal healthcare facilities. For each healthcare encounter, SPARCS identifies the care received by each
patient, including their demographic/socioeconomic profile, clinical outcomes (e.g., in-hospital death), and
resources used (e.g., hospital length of stay).

This study’s primary mortality endpoint - 30-day operative mortality - was based on the Society of Thoracic
Surgeons (STS) Adult Cardiac Surgery Database’s (ACSD) published definition, which reports both in-
hospital death and out-of-hospital deaths occurring within 30 days of the surgical procedure; this STS
ACSD definition is independent of the cause of death. For each SPARCS encounter, billing codes (e.g.,
ICD 9, ICD 10, CPT5 codes) were available to classify each patient’s diagnoses and procedures performed.
As death is not a billable event, no billing-related details could be used to reliably assess the cause of
death [9-11] . Moreover, due to the inherent nature of the SPARCS publicly available database, it is not possible
to link this de-identified database to external death certificate information. Unfortunately, no cause of death
information was separately reported within the SPARCS database; SPARCS database dictionary details can