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Kolba et al. Vessel Plus 2023;7:12 https://dx.doi.org/10.20517/2574-1209.2022.61 Page 5 of 13

into multivariable logistic regression equations predicting the three primary endpoints: (i.e., POAF, 30-day
readmission, and the MM composite).

To assure this study’s final logistic regression models were robust, sensitivity analyses were conducted to
evaluate the impact of an additional mental health propensity variable; this variable was designed to evaluate
the likelihood of mentally ill patients receiving an AVR procedure .
[21]
For all analyses performed, a protocol-driven statistical significance threshold was pre-established at
P < 0.05; however, all raw P-values are reported for ease of interpretation. In understanding the logistic
regression findings, an odds ratio (OR) > 1.00 indicated that a risk factor had an adverse outcome impact,
while an OR < 1.00 indicated a protective outcome effect. For all analyses, SAS 9.4 (SAS Institute Inc., Cary,
NC) was used.

RESULTS
From 2005 to 2018, 74,892 patients underwent an AVR procedure in New York State (SPARCS reporting
mandated by law). After removing records that were missing a unique patient identifier (n = 193), unknown
gender (n = 1), or duplicate records (n = 23), there were 74,675 records; of these, there were 73,945 first-time
AVR procedures. Within these first-time AVR patients’ records, the patients < 18 years old (n = 190) or
those admitted emergently (n = 15,925) were excluded. Additionally, patient records (n = 20,883) were
excluded due to a prior history of aortic dissections and/or a concomitant/history of prior coronary artery
bypass graft surgery, thoracic aortic aneurysm repair or mitral valve repair/replacement procedures.
Following these exclusions, 36,947 patients remained with a first-time, non-emergent aortic valve
replacement-only procedure. Of these patients, 62.22% (n = 22,989/36,947) underwent a SAVR procedure;
37.78% (n = 13,958/36,947) underwent a TAVR procedure [Figure 1].

For these 36,947 patient records, the patients with a subsequent SAVR/TAVR (r-AVR) procedure occurring
beyond 30 days following their first AVR-related operation (n = 627) were identified. Of these, 385 patient
records were excluded due to concomitant coronary artery bypass graft surgery, thoracic aortic aneurysm
repair, and/or mitral valve repair/replacement. Representative of the redo procedural population,
242 patient records with r-AVR were analyzed; this included 70.25% redo-SAVR (n = 170/242) and 29.75%
ViV-TAVR (n = 72/242) [Figure 1].

Patient demographics and risk factors
In the AVR population, the overall MEI rate was lower for TAVR (41.82%; n = 2,036/4,868) vs. for SAVR
(58.18%; n = 2,832/4,868), P < 0.001, see Table 1. There were 57.11% of women in the MEI subgroup
compared to 43.00% in the non-MEI subgroup (P < 0.001). Non-MEI patients were more frequently
reported to be of Black race (4.71%; n = 1,511/32,079) and Hispanic race (4.73%; n = 1517/32,079) compared
to MEI patients. MEI patients were younger than non-MEI patients (72.88 ± 13.11 years vs. 74.28 ± 12.79
years, P < 0.001). After evaluating the proportion of urgent vs. elective patient procedures, no significant
differences were found in the MEI patients’ admission status. For details of baseline demographics, see
Table 1.

As seen in Table 2, in the r-AVR population, there was a higher MEI rate in patients undergoing redo-
SAVR (60.98%) compared to the patients undergoing ViV-TAVR (39.02%; P = 0.154). Compared to non-
MEI patients, there were more women in the MEI subgroup (53.66% vs. 31.84%, P = 0.008). Patients with
MEI diagnoses were more likely to undergo an elective procedure compared to an urgent one (87.80% vs.
12.20%, P = 0.040); however, patients’ age, race, insurance, and ethnicity were not found to be significant
r-SAVR vs. ViV-TAVR treatment selection factors for this r-AVR population.