Thakkar Badal, Patel Aashay, Mohamad Bashar, Patel Nileshkumar J, Bhatt Parth, Bhimani Ronak, Patel Achint, Arora Shilpkumar, Savani Chirag, Solanki Shantanu, Sonani Rajesh, Patel Samir, Patel Nilay, Deshmukh Abhishek, Mohamad Tamam, Grines Cindy, Cleman Michael, Mangi Abeel, Forrest John, Badheka Apurva O
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
Catheter Cardiovasc Interv. 2016 Apr;87(5):955-62. doi: 10.1002/ccd.26345. Epub 2015 Dec 23.
To compare the in-hospital outcomes in cirrhosis patients undergoing transcatheter aortic valve replacement (TAVR) versus those undergoing surgical aortic valve replacement (SAVR).
Over the last 10 years, TAVR has emerged as a therapeutic option for treating severe aortic stenosis in high-risk patients. Cirrhosis patients have a high risk of operative morbidity and mortality while undergoing cardiac surgery. This study's hypothesis was that TAVR is a safer alternative compared to SAVR in cirrhosis patients.
The study population was derived from the National Inpatient Sample (NIS) for the years 2011-2012 using ICD-9-CM procedure codes 35.21 and 35.22 for SAVR, and 35.05 and 35.06 for TAVR. Patients <50 years of age and those who concomitantly underwent other valvular procedures were excluded. ICD-9-CM diagnosis codes were used to identify patients with liver cirrhosis, portal hypertension, and esophageal varices. Using propensity score matching, two matched cohorts were derived in which the outcomes were compared using appropriate statistical tests.
There were 30 patients in the SAVR and TAVR group each. Compared to the TAVR group, the patients in SAVR group had significantly higher rate of transfusion of whole blood or blood products (p = 0.037), longer mean postprocedural length of stay (p = 0.006), and nonsignificantly higher mean cost of hospitalization (p = 0.2), any complications rate (p = 0.09), and liver complications rate (p = 0.4). In-hospital mortality rate was same in the both the groups. No patients in the TAVR group required open-heart surgery or cardiopulmonary bypass.
TAVR could be a viable option for aortic valve replacement in cirrhosis patients.
比较经导管主动脉瓣置换术（TAVR）与外科主动脉瓣置换术（SAVR）治疗肝硬化患者的院内结局。
在过去10年中，TAVR已成为治疗高危患者严重主动脉瓣狭窄的一种治疗选择。肝硬化患者在接受心脏手术时手术发病率和死亡率风险较高。本研究的假设是，在肝硬化患者中，TAVR比SAVR是一种更安全的选择。
研究人群来自2011 - 2012年的国家住院样本（NIS），使用ICD - 9 - CM手术编码35.21和35.22代表SAVR，35.05和35.06代表TAVR。排除年龄<50岁以及同时接受其他瓣膜手术的患者。使用ICD - 9 - CM诊断编码识别肝硬化、门静脉高压和食管静脉曲张患者。采用倾向评分匹配法，得出两个匹配队列，使用适当的统计检验比较结局。
SAVR组和TAVR组各有30例患者。与TAVR组相比，SAVR组患者全血或血液制品输血率显著更高（p = 0.037），术后平均住院时间更长（p = 0.006），平均住院费用更高但无统计学意义（p = 0.2），任何并发症发生率（p = 0.09）和肝脏并发症发生率（p = 0.4）。两组的院内死亡率相同。TAVR组没有患者需要进行心脏直视手术或体外循环。
TAVR可能是肝硬化患者主动脉瓣置换的一个可行选择。
