Maan Abhishek, Heist E Kevin, Passeri Jonathan, Inglessis Ignacio, Baker Joshua, Ptaszek Leon, Vlahakes Gus, Ruskin Jeremy N, Palacios Igor, Sundt Thoralf, Mansour Moussa
Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
Am J Cardiol. 2015 Jan 15;115(2):220-6. doi: 10.1016/j.amjcard.2014.10.027. Epub 2014 Oct 29.
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18.20, p = 0.013). The composite outcome of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after TAVR was significantly higher in patients with previous AF (33 of 67 vs 19 of 70, adjusted OR 2.60, 95% CI 1.22 to 5.54, p = 0.013) compared with patients who did not have previous AF. The presence of post-TAVR AF led to a prolongation in the duration of intensive care unit stay by an average of 70 hours (95% CI 25 to 114.7 hours, p = 0.002). Similarly, post-TAVR AF also led to the prolongation in the hospital stay by an average of 6.7 days (95% CI 4.69 to 8.73 days, p <0.0005). In conclusion, our study demonstrates that the presence of AF before TAVR is an important predictor of the composite end point of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after the procedure. AF after TAVR is more likely to be encountered with the transapical approach and is associated with a prolongation of intensive care unit and hospital stay.
经导管主动脉瓣置换术(TAVR)已成为外科手术高危的重度主动脉瓣狭窄患者的一种替代治疗方法。本研究的目的是确定心房颤动(AF)对手术结果的影响。回顾了137例使用爱德华SAPIEN瓣膜接受TAVR的患者的数据。分析了术后新发心房颤动(NOAF)的预测因素。此外,根据术前和术后AF的有无,比较了TAVR后的临床结果和不良事件。接受TAVR的患者中49%既往有AF。术后,21%的患者检测到NOAF,TAVR后AF的累积发生率为60%。TAVR后,所有NOAF发作中有50%发生在术后最初24小时内。经心尖入路被观察到是NOAF的一个重要预测因素(调整后的优势比[OR]为5.05,95%置信区间[CI]为1.40至18.20,p = 0.013)。与既往无AF的患者相比,既往有AF的患者在TAVR后1个月内全因死亡、中风、血管并发症和再次住院的复合结局显著更高(67例中的33例 vs 70例中的19例,调整后的OR为2.60,95%CI为1.22至5.54,p = 0.013)。TAVR后AF的出现导致重症监护病房住院时间平均延长70小时(95%CI为25至114.7小时,p = 0.002)。同样,TAVR后AF也导致住院时间平均延长6.7天(95%CI为4.69至8.73天,p <0.0005)。总之,我们的研究表明,TAVR前AF的存在是术后1个月内全因死亡、中风、血管并发症和再次住院复合终点的重要预测因素。TAVR后AF更可能在经心尖入路时出现,并与重症监护病房和住院时间延长相关。