Vejpongsa Pimprapa, Bhise Viraj, Charitakis Konstantinos, Vernon Anderson H, Balan Prakash, Nguyen Tom C, Estrera Anthony L, Smalling Richard W, Dhoble Abhijeet
Department of Cardiology, University of Texas McGovern School of Medicine, Houston, Texas.
Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas.
Catheter Cardiovasc Interv. 2017 Oct 1;90(4):662-670. doi: 10.1002/ccd.26945. Epub 2017 Mar 2.
We aimed to determine and compare the prevalence, and predictors of readmissions after the transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).
There are limited data on the readmission rates after TAVR in comparison with SAVR.
We analyzed the data from 2013 National Readmission Database. Propensity-matched pairs were used to analyze differences in readmission rates between TAVR and SAVR for patients aged ≥65.
A total of 24,020 (TAVR-transfemoral 3,469, TAVR-transapical 1,433, SAVR 19,118) patients were included. The readmission rates were not statistically different for all propensity-matched TAVR and SAVR patients (17.2% vs. 20.6%, P = 0.28). However, in subgroup analysis, transapical TAVR had the highest readmission rate (22.8% vs. 16.5% vs. 16.0%, P < 0.001, respectively) and readmission leading to death (7.1% vs. 5.3% vs. 3.9%, P = 0.022, respectively) when compared with transfemoral TAVR and SAVR. In all the groups, two-thirds of readmissions were due to noncardiac causes. Congestive heart failure (CHF) and arrhythmia were the most frequent cardiac etiologies. The independent predictors of readmission were female sex, CHF, and chronic obstructive pulmonary disease. Patients who received care in teaching hospitals had lower probability of readmission.
One of six patients were readmitted within 30 days after the aortic valve replacement. On propensity score analysis, there were no significant differences between the early readmission rates between TAVR and SAVR groups. However, the patients undergoing transapical TAVR were at higher risk for readmission, and subsequent deaths when compared with transfemoral TAVR and SAVR. © 2017 Wiley Periodicals, Inc.
我们旨在确定并比较经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）后再入院的发生率及预测因素。
与SAVR相比，关于TAVR后再入院率的数据有限。
我们分析了2013年国家再入院数据库中的数据。倾向评分匹配对用于分析年龄≥65岁的患者中TAVR和SAVR再入院率的差异。
共纳入24,020例患者（经股动脉TAVR 3,469例，经心尖TAVR 1,433例，SAVR 19,118例）。所有倾向评分匹配的TAVR和SAVR患者的再入院率无统计学差异（17.2%对20.6%，P = 0.28）。然而，在亚组分析中，与经股动脉TAVR和SAVR相比，经心尖TAVR的再入院率最高（分别为22.8%对16.5%对16.0%，P < 0.001），且因再入院导致死亡的比例也最高（分别为7.1%对5.3%对3.9%，P = 0.022）。在所有组中，三分之二的再入院是由非心脏原因引起的。充血性心力衰竭（CHF）和心律失常是最常见的心脏病因。再入院的独立预测因素为女性、CHF和慢性阻塞性肺疾病。在教学医院接受治疗的患者再入院概率较低。
六分之一的患者在主动脉瓣置换术后30天内再次入院。倾向评分分析显示，TAVR组和SAVR组的早期再入院率无显著差异。然而，与经股动脉TAVR和SAVR相比，接受经心尖TAVR的患者再入院及随后死亡的风险更高。©2017威利期刊公司。
