Clinical Outcomes at 1 Year Following Transcatheter Aortic Valve Replacement

Supplementary Online Content

Holmes DR, Brennan JM, Rumsfeld JS, et al; STS/ACC TVT Registry. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. doi:10.1001/jama.2015.1474

eFigure 1. Study Cohort Development of TAVR Patients From Nov. 2011 to June 2014 eFigure 2. Cumulative Incidence of Outcomes by Society of Thoracic Surgeons Predicted Risk of Mortality eFigure 3. Cumulative Incidence of Outcomes by Age eFigure 4. Cumulative Incidence of Outcomes by Sex eFigure 5. Cumulative Incidence of Outcomes by Renal Failure eFigure 6. Cumulative Incidence of Outcomes by Left Ventricular Ejection Fraction eFigure 7. Cumulative Incidence of Outcomes by Access Site eFigure 8. Cumulative Incidence of Outcomes by Preoperative Atrial Fibrillation/Flutter eFigure 9. Cumulative Incidence of Outcomes by Chronic Obstructive Pulmonary Disease eAppendix 1. STS/ACC TVT Registry Participating Hospitals eAppendix 2. Definitions eAppendix 3. Patient Characteristics for Medicare-Linked Patients Who Were Excluded From the Study Cohort eAppendix 4. In-Hospital Outcomes for Medicare-Linked Patients Who Were Excluded From the Study Cohort

This supplementary material has been provided by the authors to give readers additional information about their work.

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 1. Study Cohort Development of TAVR Patients From Nov. 2011 to June 2014

TAVR patients Nov. 2011 – Jun. 2014 65+ years old with Medicare Insurance N=15,792 admissions of 15,658 patients at 304 sites

Exclude records not linked to Exclude records from Exclude records whose index Medicare patients without Part A & B admission is not linked to N=442 admissions, 68 sites and Fee-For-Service Medicare inpatient claims N=208 admissions, 118 sites N=2,856 admissions, 267sites

Include only the index admission of each patient Exclude N=104 admissions, 299 sites

Patient population studied N=12,182 admissions of 12,182 patients at 299 sites

In the final study population, 5 sites were excluded from the original 304 sites, because all the patients in those sites could not be linked to Medicare, or did not have Part A&B/Fee-For-Service, or their index admissions could not be linked to Medicare inpatient claims.

Downloaded From: https://jamanetwork.com/ on 09/29/2021 © 2015 American Medical Association. All rights reserved. eFigure 2. Cumulative Incidence of Outcomes by Society of Thoracic Surgeons Predicted Risk of Mortality

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 2. Cumulative Incidence of Heart Failure by Society of Thoracic Surgeons Predicted Risk of Mortality (continued)

C. Heart Failure

D. AVRI

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 3. Cumulative Incidence of Outcomes by Age

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 3. Cumulative Incidence of Outcomes by Age (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 4. Cumulative Incidence of Outcomes by Sex

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 4. Cumulative Incidence of Outcomes by Sex (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 5. Cumulative Incidence of Outcomes by Renal Failure

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 5. Cumulative Incidence of Outcomes by Renal Failure (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 6. Cumulative Incidence of Outcomes by Left Ventricular Ejection Fraction

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure; LVEF = Left Ventricular Ejection Fraction

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 6. Cumulative Incidence of Outcomes by Left Ventricular Ejection Fraction (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

AVRI = Aortic Valve Re-intervention; HF = Heart Failure; LVEF = Left Ventricular Ejection Fraction

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 7. Cumulative Incidence of Outcomes by Access Site

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 7. Cumulative Incidence of Outcomes by Access Site (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 8. Cumulative Incidence of Outcomes by Preoperative Atrial Fibrillation/Flutter

A. Mortality

B. Stroke

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 8. Cumulative Incidence of Outcomes by Preoperative Atrial Fibrillation/Flutter (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

AVRI = Aortic Valve Re-intervention; HF = Heart Failure

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 9. Cumulative Incidence of Outcomes by Chronic Obstructive Pulmonary Disease

A. Mortality

B. Stroke

COPD categories are defined as follows: None = No documented chronic lung disease; Mild = FEV1 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy; Moderate=FEV1 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease; Severe = FEV1 <50% predicted, and/or Room Air pO2 < 60 or Room Air pCO2 > 50.

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eFigure 9. Cumulative Incidence of Outcomes by Chronic Obstructive Pulmonary Disease (continued)

C. Heart Failure

D. Aortic Valve Re-intervention

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eAppendix 1. STS/ACC TVT Registry Participating Hospitals Facility Name City State Huntsville Hospital Huntsville AL Princeton Baptist Medical Center Birmingham AL Springhill Hospital Inc Mobile AL St. Vincent Hospital Birmingham AL University of Alabama Hospital Birmingham AL Arkansas Heart Hospital Little Rock AR CHI St Vincent Infirmary Little Rock AR Banner Good Samaritan Med Ctr Phoenix AZ Banner Heart Hospital Phoenix AZ Mayo Clinic Arizona Phoeniz AZ Saint Joseph's Hospital Phoenix AZ Scottsdale Healthcare Shea Scottsdale AZ Tucson Medical Center Tucson AZ UAMC â€“ University Campus Tucson AZ Yuma Regional Medical Center Yuma AZ Alta Bates Summit Medical Center Oakland CA Cedars-Sinai Health Systems Los Angeles CA El Camino Hospital Mountain View CA Fresno Community Hospital and Medical Center Fresno CA Good Samaritan Hospital Los Angeles CA Harbor UCLA Medical Center Torrance CA Hoag Memorial Hospital Presbyterian Newport Beach CA John Muir Medical Center - Concord Campus Walnut Creek CA Kaiser Permanente Medical Center San Francisco CA Keck Hospital of USC Los Angeles CA Long Beach Memorial Medical Center Long Beach CA Los Robles Hospital & Medical Center Thousand Oaks CA Mercy General Hospital - Sacramento Sacramento CA Saint Agnes Medical Center Fresno CA Saint Bernadine Medical Center San Bernardino CA Scripps Green Hospital La Jolla CA Scripps Memorial Hospital-La Jolla La Jolla CA Sharp Grossmont Hospital La Mesa CA Sharp Memorial Hospital San Diego CA Stanford HEALTH CARE Palo Alto CA Sutter Medical Center - Sacramento Sacramento CA Torrance Memorial Medical Center Torrance CA UC San Diego Health System Sulpizio CV Center La Jolla CA University of California (UCLA) Los Angeles CA University Of California Davis Medical Center Sacramento CA

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State Exempla Saint Joseph Hospital Denver CO Medical Center of the Rockies Loveland CO Penrose Hospital Colorado Springs CO University of Colorado Hospital Authority Aurora CO Danbury Hospital Danbury CT HARTFORD HOSPITAL Hartford CT St. Vincent's Medical Center Bridgeport CT Yale New Haven Hospital New Haven CT MedStar Washington Hospital Center Washington DC National Outcomes Report Washington DC The George Washington University Hospital Washington DC Christiana Care Health System Newark DE Baptist Hospital of Miami, Inc Miami FL Baptist Hospital, Inc. Pensacola FL Blake Medical Center Bradenton FL Broward Health Medical Center Fort Lauderdale FL Florida Hospital Orlando FL Florida Hospital Tampa, Pepin Heart Institute Tampa FL Holy Cross Hospital Fort Lauderdale FL JFK Medical Center Atlantis FL Lakeland Regional Medical Center Lakeland FL Lee Memorial Health System-Health Park Med Ctr Fort Myers FL Leesburg Regional Medical Center Leesburg FL Mayo Clinic Jacksonville FL Memorial Hospital Jacksonville JACKSONVILLE FL Memorial Regional Hospital/ South Broward Hospital Hollywood FL Morton Plant Hospital Clearwater FL Mount Sinai Medical Center Miami Beach FL Munroe Regional Medical Center Ocala FL Orlando Regional Medical Center Orlando FL Palm Beach Gardens Medical Center Palm Beach Gardens FL Sarasota Memorial Hospital Sarasota FL St. Joseph's & St. Joseph's Children's Hospitals Tampa FL St. Vincent's Medical Center Jacksonville FL Tallahassee Memorial Hospital Tallahassee FL Tampa General Hospital Tampa FL University of Florida (shands)College of Medicine Gainesville FL University of Miami Hospital Miami FL Athens Regional Medical Center Athens GA Emory Saint Josephs Hospital of Atlanta Atlanta GA Emory University Hospital Atlanta GA

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State Emory University Hospital Midtown Atlanta GA Northeast Georgia Medical Center Gainesville GA Piedmont Hospital Atlanta GA St. Joseph's Hospital Savannah GA University Hospital Augusta GA Wellstar Kennestone Regional Medical Center Marietta GA The Queen's Medical Center Honolulu HI Genesis Medical Center, Davenport Davenport IA Mercy Medical Center-Des Moines Des Moines IA University of Iowa Hospitals and Clinics Iowa City IA Portneuf Medical Center Pocatello ID St. Lukes Health System Boise ID Advocate Christ Medical Center Oak Lawn IL Alexian Brothers Medical Center Elk Grove Village IL Carle Foundation Hospital Urbana IL Edward Hospital Naperville IL Loyola University Medical Center Maywood IL North Shore University Health System Cardiology Evanston IL Northwestern Memorial Hospital Chicago IL OSF Saint Anthony Medical Center Rockford IL OSF Saint Francis Medical Center Peoria IL Prairie Heart Institute at St. John's Hospital Springfield IL Rush University Medical Center Chicago IL University of Chicago Hospitals Chicago IL Elkhart General Hospital Elkhart IN Franciscan St. Francis Health Indianapolis IN Indiana Heart Hospital Indianapolis IN Indiana University Health Methodist Hospital Indianapolis IN Lutheran Hospital of Indiana Ft. Wayne IN Parkview Regional Medical Center Fort Wayne IN St. Vincent Heart Center@ 106th Street Indianapolis IN Kansas University Hospital Authority Westwood KS Via Christi Hospitals Wichita Wichita KS Wesley Medical Center Wichita KS Baptist Health Lexington Lexington KY Jewish Hospital Louisville KY Kings Daughters Medical Center Ashland KY St. Joseph Hospital Lexington KY UNIVERSITY OF KENTUCKY lexington KY Ochsner Clinic Foundation New Orleans LA Our Lady of The Lake Regional Regional Medical Ctr Baton Rouge LA Regional Medical Center of Acadiana Lafayette LA

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State Terrebonne General Medical Center Houma LA Willis-Knighton Medical Center Shreveport LA Baystate Medical Center Springfield MA Beth Israel Deaconess Medical Center Boston MA Brigham & Womens Hospital Boston MA Charlton Memorial Hospital Fall River MA Lahey Hospital and Medical Center Burlington MA Massachusetts General Hospital Boston MA St. Elizabeth's Medical Center Brighton MA Tufts Medical Center Boston MA UMASS Memorial Medical Center Worcester MA Johns Hopkins Hospital Baltimore MD Union Memorial Hospital Baltimore MD University of Maryland Medical Ctr Cardiology Baltimore MD Maine Medical Center Portland ME Borgess Medical Center Kalamazoo MI Bronson Methodist Hospital Kalamazoo MI Covenant Healthcare Saginaw MI Edward W Sparrow Hospital Assoc Lansing MI Harper University Hospital Detroit MI McLaren Northern Michigan Petoskey MI Munson Medical Center Traverse City MI Oakwood Hospital & Medical Center Dearborn MI Regents of the University of Michigan Ann Arbor MI Saint John Hospital & Medical Center Grosse Pointe MI Spectrum Health Grand Rapids MI St Joseph Hospital-Oakland Pontiac MI St. Joseph Mercy Hospital Ypsilanti MI William Beaumont Hospital Royal Oak MI Abbott Northwestern Hospital Minneapolis MN CentraCare Heart & Vascular Center St. Cloud MN Essentia Health -St. Mary's Medical Center Duluth MN Mayo Clinic Hospital - Saint Marys Campus Rochester MN Regions Hospital St Paul MN University of Minnesota Medical Center Minnepolis MN Barnes Jewish Hospital/Washington University Saint Louis MO LE Cox Medical Centers Springfield MO MERCY Hospital Springfield Springfield MO Mercy Hospital St. Louis St.louis MO Missouri Baptist Medical Center St. Louis MO Saint Luke's Hospital of Kansas City Kansas City MO Mississippi Baptist Medical Center Jackson MS

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State North Mississippi Medical Center Tupelo MS Providence St. Patrick Hospital Missoula MT St. Vincent Healthcare Billings MT Carolinas Medical Center Charlotte NC ConeHealth Greensboro NC Duke University Hospital Durham NC FirstHealth Moore Regional Hospital Pinehurst NC Mission Hospital, Inc. Asheville NC New Hanover Regional Medical Center Wilmington NC North Carolina Baptist Hospital Winston-Salem NC Novant Health Forsyth Medical Center Winston-Salem NC Novant Health Presbyterian Medical Center Charlotte NC Rex Hospital Raleigh NC Vidant Medical Center Greenville NC WakeMed Raleigh Campus Raleigh NC Sanford Fargo Medical Center Fargo ND Bryan Medical Center LINCOLN NE CHI Health Bergan Mercy omaha NE The Nebraska Medical Center Omaha NE Catholic Medical Center Manchester NH Mary Hitchcock Memorial Hospital Lebanon NH Atlanticare Regional Medical Center Pomona NJ Cooper University Hospital Camden NJ Deborah Heart & Lung Center Browns Mills NJ Englewood Hospital & Medical Center Englewood NJ Hackensack University Medical Center Hackensack NJ Jersey Shore University Medical Center Neptune NJ Morristown Medical Center Morristown NJ Newark Beth Israel Medical Center Newark NJ Our Lady of Lourdes Medical Center Camden NJ Robert Wood Johnson University Hospital New Brunswick NJ St. Joseph Regional Medical Center Paterson NJ The Valley Hospital Ridgewood NJ Presbyterian Healthcare Services albuqerque NM Dignity Health St. Rose Dominican Siena Henderson NV Sunrise Hospital and Medical Center Las Vegas NV Albany Medical Center Hospital Albany NY Gates Vascular Institute Buffalo NY Lenox Hill Heart and Vascular Institute of New Yor NY NY Long Island Jewish Medical Center New Hyde Park NY Maimonides Medical CenterDivision of Cardiology Brooklyn NY Montefiore Medical Center Bronx NY

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State New York Methodist Hospital Brooklyn NY New York Presbyterian - Weill Cornell Medical Cen NY NY NewYork-Presbyterian-Columbia University Medical C NY NY North Shore University Hospital Manhasset NY NYU Langone Medical Center New York NY Southside Hospital Bay Shore NY St Josephs Hospital Health Center Syracuse NY St. Francis Hospital Roslyn NY St. Peter's Hospital Albany NY Stony Brook University Hospital Stony Brook NY The Mount Sinai Medical Center New York NY University of Rochester Medical Center Rochester NY Westchester County Medical Center Valhalla NY Winthrop University Hospital Mineola NY Cleveland Clinic Foundation Cleveland OH Good Samaritan Hospital Cincinnati OH Mercy Health Fairfield Hospital Fairfield OH Miami Valley Hospital Dayton OH Mount Carmel East Columbus OH Riverside Methodist Hospital Columbus OH Summa Akron City Hospital Akron OH The Christ Hospital Health Network Cincinnati OH The Ohio State University Medical Center Columbus OH The Toledo Hospital Toledo OH University Hospitals Case Medical Center Cleveland OH Hillcrest Medical Center Tulsa OK INTEGRIS Baptist Medical Center Oklahoma City OK Oklahoma Heart Hospital Oklahoma City OK Saint Francis Hospital Tulsa OK St. John Medical Center, Inc. Tulsa OK Kaiser Sunnyside Medical Center Clackamas OR Oregon Health & Science University Portland OR Providence Saint Vincent Med Ctr Portland OR Sacred Heart Medical Center Eugene OR Abington Memorial Hospital Abington PA Albert Einstein Medical Center Philadelphia PA Doylestown Hospital Doylestown PA Geisinger Medical Center Danville PA Geisinger Wyoming Valley Medical Center Danville PA Hamot Medical Center Erie PA Holy Spirit Health System Camp Hill PA

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State Hospital of the University of Pennsylvania Philadelphia PA Lancaster General Health Lancaster PA Lankenau Medical Center Wynnewood PA Lehigh Valley Hospital Allentown PA Penn Presbyterian Medical Center Philadelphia PA Penn State Hershey Medical Center Hershey PA Pinnacle Health System: Harrisburg Hospital Harrisburg PA Reading Hospital West Reading PA Robert Packer Hospital Sayre PA Saint Vincent Health Center Erie PA St. Joseph Medical Center Reading PA St. Lukes UniversityHealth Network Bethlehem PA St. Mary Medical Center Langhorne PA Temple University Hospital Philadelphia PA Thomas Jefferson University Hospital Philadelphia PA UPMC Presbyterian Hospital Pittsburgh PA UPMC Shadyside Hospital Pittsburgh PA WEST PENN ALLEGHENY HEALTH SYSTEM INC. Pittsburgh PA York Hospital York PA Hospital Pavia Santurce San Juan PR Rhode Island Hospital Providence RI Greenville Memorial Hospital Greenville SC Lexington Medical Center West Columbia SC Medical University of South Carolina Charleston SC Palmetto Health Richland Columbia SC Providence Hospital Columbia SC Avera Heart Hospital of South Dakota Sioux Falls SD Rapid City Regional Hospital rapid City SD Sanford Health Sioux Falls SD Baptist Memorial Hospital Memphis Memphis TN Holston Valley Medical Center Kingsport TN Jackson Madison County General Hospital Jackson TN Memorial Hospital Chattanooga TN Methodist Hospital University Memphis TN Parkwest Medical Center Knoxville TN Saint Thomas West Hospital Nashville TN TriStar Centennial Medical Center Nashville TN University of Tennessee Medical Center Knoxville TN Vanderbilt University Medical Center Nashville TN Baptist Hospital of Southeast Texas Beaumont TX Baylor Jack and Jane Hamilton Heart and Vascular H Dallas TX BaylorScott&WhiteHealth Temple TX

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State CHI/Baylor St. Luke's Medical Center Houston TX Christus Spohn Hospital Corpus Christi - Shoreline Corpus Christi TX Covenant Heart Institute Lubbock TX Heart Hospital of Austin Austin TX Medical City Dallas Hospital Dallas TX Memorial Hermann Southwest Houston TX Memorial Hermann Hospital TMC Houston TX Methodist Hospital San Antonio TX Presbyterian Hospital of Dallas Dallas TX Seton Medical Center Austin Austin TX Sierra Medical Center El Paso TX The Heart Hospital Baylor Plano Plano TX The Methodist DeBakey Heart and Vascular Center Houston TX University Health System San Antonio TX University of Texas Southwestern-University Hospit Dallas TX CHI Health Nebraska Heart Lincoln UM Intermountain Medical Center Murray UT ST. Marks Hospital/ Northern Utah Healthcare Corpo Salt Lake City UT University of Utah Hospitals and Clinics Salt Lake City UT Carilion Roanoke Memorial Hosp Roanoke VA Henrico Doctors Hospital Richmond VA Inova Fairfax Hospital/Inova Heart & Vascular Inst Falls Church VA Sentara Norfolk General Hospital Norfolk VA University of Virginia Medical Center Charlottesville VA VCU-Medical College Of Virginia Richmond VA Fletcher Allen Health Care Burlington VT Henry Ford Heart and Vascular Institute Detroit WA Overlake Hospital Medical Center Bellevue WA Sacred Heart Medical Center Spokane WA Swedish Health Services Seattle WA Tacoma General Hospital Tacoma WA University of Washington Medical Center Seattle WA Aspirus Wausau Hospital Wausau WI Aurora St. Lukes Medical Center Milwaukee WI Bellin Memorial Hospital Green Bay WI Gundersen Lutheran Medical Center, Inc. La Crosse WI Meriter Hospital Madison WI Saint Josephs Hospital / Marshfield Clinic Marshfield WI St. Mary's Hospital Madison WI University of Wisconsin Hospital & Clinics Madison WI Charleston Area Medical Center Charleston WV

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Facility Name City State Monongalia General Hospital Morgantown WV Saint Mary's Medical Center Huntington WV West Virginia University Hospitals Inc Morgantown WV

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eAppendix 2. Definitions

1. Chronic Obstructive Pulmonary Disease is categorized as one of the following: • None: No documented chronic lung disease. • Mild: FEV1 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy. • Moderate FEV1 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease. • Severe FEV1 <50% predicted, and/or Room Air pO2 < 60 or Room Air pCO2 > 50. 2. Hostile chest is categorized as: Indicate if the patient has a medical condition that precludes an open chest procedure and that is documented in the medical record. This can include any of the following or other reasons that make redo operation through sternotomy or right anterior thoracotomy prohibitively hazardous: • Evidence of abnormal chest wall anatomy due to severe kyphoscoliosis or other skeletalotts’ disease, sternal bone destruction, evidence of indetectable plane between posterior sternal table and important mediastinal structures). • Complications from prior surgery. • Prior radiation involving the mediastinum/thoracic, or evidence of severe radiation damage (e.g., skin burns, bone destruction, muscle loss, lung fibrosis or esophageal stricture) • History of multiple recurrent pleural effusions causing internal adhesions. • Chronic, ongoing open skin defects or extremely severe soft tissue atrophy. • Complete absence of reconstructive options based on plastic surgeon consult. 3. Porcelain aorta is categorized as: Indicate if the patient has a porcelain aorta as documented by findings on a chest x-ray, CT scan, fluoroscopy at the time of cardiac catheterization or noted during previous cardiothoracic surgery. 4. Mitral insufficiency is categorized as: • Mild: Mild mitral insufficiency or regurgitation is defined as the following: o Qualitative:¬Angiographic grade 1+; o Color Doppler jet area is small, central jet (<4cm(2) or <20% left atrial area); o Doppler vena contracta width <0.3 cm. o Quantitative (cath or echo) o Regurgitant volume <30 ml/beat; o Regurgitant fraction <30%; o Regurgitant orifice area <0.20 cm(2)

Downloaded From: https://jamanetwork.com/ on 09/29/2021 • Moderate: Moderate mitral insufficiency or regurgitation is defined as the following: o Qualitative: o Angiographic grade 2+; o Color Doppler jet area shows signs of mitral regurgitation greater than mild present but no criteria for severe mitral regurgitation; o Doppler vena contracta width 0.30 -0.69 cm. o Quantitative (cath or echo) o Regurgitant volume 30-59 ml/beat; o Regurgitant fraction 30-49%; o Regurgitant orifice area 0.20-0.39 cm(2) • o Severe: Severe mitral insufficiency or regurgitation is defined as the following: o Qualitative: o Angiographic grade 3-4+; o Color Doppler jet area –vena contracta width greater than 0.7 cm with large central mitral regurg jet (area >40% of left atrial area) or with a wall-impinging jet of any size, swirling in the left atrium; o Doppler vena contracta width >0.70 cm. o Quantitative (cath or echo) o Regurgitant volume >=60 ml/beat; o Regurgitant fraction >=50%; o Regurgitant orifice area >=0.40 cm(2) o Additional essential criteria-Left atrial size –enlarged; o Left ventricular size – enlarged.

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eAppendix 3. Patient Characteristics for Medicare-Linked Patients Who Were Excluded From the Study Cohort Excluded but Overall Study Cohort Medicare Linked (N=15,658) (N=12,182) (N=3,476) p Value Age – yr Median (25th, 75th) 84 (79,88) 84 (79,88) 84 (78,88) <.001 <.001 <75, n(%) 2,059 (13.1) 1,546 (12.7) 513 (14.8) 75-84 6,071 (38.8) 4,652 (38.2) 1,419 (40.8) 85-94 7,205 (46.0) 5,726 (47.0) 1,479 (42.5) 95+ 323 (2.1) 258 (2.1) 65 (1.9) Female, n (%) 8,026 (51.4) 6,316 (51.9) 1,710 (49.5) 0.011 Race <.001 White 14,823 (94.7) 11,615 (95.3) 3,208 (92.3) Black 502 (3.2) 346 (2.8) 156 (4.5) Asian 177 (1.1) 108 (0.9) 69 (2.0) Other 156 (1.0) 113 (0.9) 43 (1.2) STS PROM Score (median, 25th, 7.1 (4.7,10.7) 7.1 (4.8,10.8) 6.9 (4.5,10.5) 0.004 75th) 0.052 <8%, n(%) 9,049 (57.8) 6,988 (57.4) 2,061 (59.3) 8-15% 4,768 (30.5) 3,748 (30.8) 1,020 (29.3) >15% 1,839 (11.7) 1,444 (11.9) 395 (11.4) NYHA Class III/IV Heart Failure, 12,730 (82.8) 9,879 (82.5) 2,851 (84.0) 0.048 n (%) Coronary Artery Disease, n (%) 9,699 (63.2) 7,504 (62.8) 2,195 (64.7) 0.045 Prior Open Heart Surgery 5,367 (34.3) 4,145 (34.0) 1,222 (35.2) 0.216 # Prior Cardiac Surgeries, n (%) 0.192 0 10,259 (67.6) 8,016 (67.9) 2,243 (66.7) 1 4,199 (27.7) 3,247 (27.5) 952 (28.3) >=2 715 (4.7) 548 (4.6) 167 (5.0) Prior Aortic Valve Intervention, 2,475 (15.8) 1,926 (15.8) 549 (15.8) 0.979 n (%) Balloon Aortic Valvuloplasty 2,206 (89.1) 1,720 (89.3) 486 (88.5) 0.605 Surgical AVR 256 (1.6) 195 (1.6) 61 (1.8) 0.527 TAVR 12 (0.5) 10 (0.5) 2 (0.4) 0.645 Previous Stroke, n (%) 1,915 (12.3) 1,489 (12.2) 426 (12.3) 0.963 Peripheral Arterial Disease, n 5,091 (32.6) 3,935 (32.4) 1,156 (33.4) 0.271 (%) COPD, n (%) 0.023 None/mild 11,224 (72.5) 8,694 (72.2) 2,530 (73.6) Moderate 2,158 (13.9) 1,709 (14.2) 449 (13.1) Severe 2,098 (13.6) 1,640 (13.6) 458 (13.3) Oxygen-dependent Lung 2,139 (13.8) 1,704 (14.1) 435 (12.7) 0.028 Disease, n (%) Renal Failure, n (%) 0.303 Dialysis Dependent 582 (3.7) 474 (3.9) 108 (3.1) Serum Creatinine >=2.0 1,034 (6.6) 798 (6.6) 236 (6.8) without Dialysis Serum Creatinine <2.0 13,978 (89.6) 10,861 (89.5) 3,117 (90.1) 5m Walk Time >6 sec 6,145 (39.6) 4,775 (39.6) 1,370 (39.7) 0.896 Atrial fibrillation, n (%) 6,503 (41.6) 5,086 (41.9) 1,417 (40.8) 0.265 Permanent pacemaker/ICD, n 3,022 (19.3) 2,394 (19.7) 628 (18.1) 0.036 (%) Hostile Chest, n (%) 1,266 (8.2) 993 (8.2) 273 (8.0) 0.603

Downloaded From: https://jamanetwork.com/ on 09/29/2021 Excluded but Overall Study Cohort Medicare Linked (N=15,658) (N=12,182) (N=3,476) p Value Porcelain Aorta, n (%) 1,085 (7.0) 817 (6.8) 268 (7.8) 0.043 LV ejection fraction 0.067 <30%, n (%) 1,081 (7.1) 836 (7.1) 245 (7.3) 30-45% 2,840 (18.7) 2,177 (18.4) 663 (19.8) >45% 11,241 (74.1) 8,803 (74.5) 2,438 (72.9) Aortic Valve Morphology, n (%) 0.022 Bicuspid 224 (1.4) 158 (1.3) 66 (1.9) Tricuspid 14,273 (91.2) 11,131 (91.4) 3,142 (90.4) Other/Unknown 1,161 (7.4) 893 (7.3) 268 (7.7) Pre-TAVR Mitral Insufficiency, n 0.701 (%) None/trivial/mild 8,412 (63.4) 6,562 (63.4) 1,850 (63.6) Moderate 4,115 (31.0) 3,222 (31.1) 893 (30.7) Severe 733 (5.5) 568 (5.5) 165 (5.7) Access site 0.666 Transfemoral 8,730 (56.3) 6,807 (56.4) 1,923 (56.0) Other 6,766 (43.7) 5,256 (43.6) 1,510 (44.0)

Downloaded From: https://jamanetwork.com/ on 09/29/2021 eAppendix 4. In-Hospital Outcomes for Medicare-Linked Patients Who Were Excluded From the Study Cohort

Excluded but Medicare Overall Study Cohort Linked (N=15,658) (N=12,182) (N=3,476) p Value Inhosptial death 830 (5.3) 633 (5.2) 197 (5.7) 0.274 Any inhospital stroke 320 (2.1) 231 (1.9) 89 (2.6) 0.015 Inhospital TIA 43 (0.3) 34 (0.3) 9 (0.3) 0.842 Any inhospital valve complication 314 (2.0) 236 (1.9) 78 (2.3) 0.254 Conversion to open heart surgery 222 (1.4) 169 (1.4) 53 (1.5) 0.545 Discharge location <.001 Home 9,033 (61.0) 6,907 (59.8) 2,126 (64.9) Extended care/TCU/rehab 4,631 (31.3) 3,733 (32.3) 898 (27.4) Other acute care hospital 99 (0.7) 75 (0.6) 24 (0.7) Nursing home 912 (6.2) 722 (6.3) 190 (5.8) Hospice 86 (0.6) 64 (0.6) 22 (0.7) Other 54 (0.4) 40 (0.3) 14 (0.4)

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