Young Michael N, Elmariah Sammy, Kennedy Kevin F, Inglessis Ignacio, Yeh Robert W
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
Catheter Cardiovasc Interv. 2017 Nov 1;90(5):830-838. doi: 10.1002/ccd.27018. Epub 2017 Mar 22.
The objective of this study was to assess the national uptake of TAVR, associated in-hospital outcomes, and the effect of procedural experience on outcomes in the first two years following device approval.
Transcatheter aortic valve replacement (TAVR) is a newly established therapy for high-risk patients with severe aortic stenosis. Evaluating the manner in which TAVR has disseminated into real-world practice is essential for understanding its impact on population health.
We identified patients undergoing TAVR from the National Inpatient Sample from January 2012 through December 2013. During this period, an estimated 21,185 cases were performed in the United States. Mean age was 81.1 years, 50.8% were male, 86.5% were Caucasian, and 89.6% were Medicare patients. The number of TAVRs performed and of hospitals performing the procedure nationally grew linearly throughout the study period. The most frequent complications included bleeding (26.9%), respiratory failure (19.3%), and renal/metabolic issues (17.2%). Median hospital length of stay was 6 days (IQR 4-10). In-hospital mortality was estimated to be 4.9%. A majority of cases were performed in large (80.8%) and in urban teaching (87%) hospitals. In the first year post-market approval, prior institutional experience with TAVR was associated with significantly reduced risk-adjusted, in-hospital mortality (OR 0.82 per 25 additional TAVRs performed, CI 0.70-0.951, P = 0.009).
Following device approval, the number of TAVRs and hospitals performing TAVR grew dramatically. Procedural complications were frequent and in-hospital mortality was approximately 4.9%. Finally, increased procedural experience was strongly associated with a reduction in inpatient mortality. © 2017 Wiley Periodicals, Inc.
本研究的目的是评估经导管主动脉瓣置换术（TAVR）在全国范围内的应用情况、相关的住院结局，以及在器械获批后的头两年中手术经验对结局的影响。
经导管主动脉瓣置换术（TAVR）是一种针对高危重度主动脉瓣狭窄患者的新确立的治疗方法。评估TAVR在实际临床实践中的传播方式对于理解其对人群健康的影响至关重要。
我们从2012年1月至2013年12月的全国住院患者样本中识别出接受TAVR的患者。在此期间，美国估计进行了21,185例手术。平均年龄为81.1岁，50.8%为男性，86.5%为白种人，89.6%为医疗保险患者。在整个研究期间，全国范围内进行的TAVR手术数量和开展该手术的医院数量呈线性增长。最常见的并发症包括出血（26.9%）、呼吸衰竭（19.3%）和肾脏/代谢问题（17.2%）。中位住院时间为6天（四分位间距4 - 10天）。住院死亡率估计为4.9%。大多数手术在大型医院（80.8%）和城市教学医院（87%）进行。在上市批准后的第一年，先前机构的TAVR经验与风险调整后的住院死亡率显著降低相关（每多进行25例TAVR手术，比值比为0.82，可信区间0.70 - 0.951，P = 0.009）。
器械获批后，TAVR手术数量和开展TAVR的医院数量急剧增加。手术并发症频繁，住院死亡率约为4.9%。最后，手术经验的增加与住院死亡率的降低密切相关。© 2017威利期刊公司。
