维持性透析患者经导管与外科主动脉瓣置换术的疗效
Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis.
作者信息
Alqahtani Fahad, Aljohani Sami, Boobes Khaled, Maor Elad, Sherieh Assem, Rihal Charanjit S, Holmes David R, Alkhouli Mohamad
机构信息
West Virginia University Heart & Vascular Institute, Morgantown.
Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Ill.
出版信息
Am J Med. 2017 Dec;130(12):1464.e1-1464.e11. doi: 10.1016/j.amjmed.2017.05.031. Epub 2017 Jun 14.
BACKGROUND
The introduction of transcatheter aortic valve replacement (TAVR) expanded definitive therapy of aortic stenosis to many high-risk patients, but it has not been fully evaluated in the dialysis population. We aimed to evaluate the current trend and in-hospital outcome of surgical aortic valve replacement (SAVR) and TAVR in the dialysis population.
METHODS
Severe aortic stenosis patients on maintenance dialysis who underwent SAVR or TAVR in the Nationwide Inpatient Sample database from January 1, 2005, through December 31, 2014, were included in our comparative analysis. The trends of SAVR and TAVR were assessed. In-hospital mortality, rates of major adverse events, hospital length of stay, cost of care, and intermediate care facility utilization were compared between the 2 groups using both unadjusted and propensity-matched data.
RESULTS
Utilization of aortic valve replacement in dialysis patients increased 3-fold; a total of 2531 dialysis patients who underwent either SAVR (n = 2264) or TAVR (n = 267) between 2005 and 2014 were identified. Propensity score matching yielded 197 matched pairs. After matching, a 2-fold increase in in-hospital mortality was found with SAVR compared with TAVR (13.7% vs 6.1%, P = .021). Patients who underwent TAVR had more permanent pacemaker implantation (13.2% vs 5.6%, P = .012) but less blood transfusion (43.7% vs 56.8%, P = .02). Rates of other key morbidities were similar. Hospital length of stay (19 ± 16 vs 11 ± 11 days, P <.001) and non-home discharges (44.7% vs 31.5%, P = .002) were significantly higher with SAVR. Cost of hospitalization was 25% less with TAVR.
CONCLUSION
In patients on maintenance dialysis, TAVR is associated with lower hospital mortality, resource utilization, and cost in comparison with SAVR.
背景
经导管主动脉瓣置换术（TAVR）的引入将主动脉瓣狭窄的确定性治疗扩展至许多高危患者，但尚未在透析人群中得到充分评估。我们旨在评估透析人群中外科主动脉瓣置换术（SAVR）和TAVR的当前趋势及院内结局。
方法
纳入2005年1月1日至2014年12月31日期间在全国住院患者样本数据库中接受SAVR或TAVR的维持性透析重度主动脉瓣狭窄患者进行比较分析。评估SAVR和TAVR的趋势。使用未调整数据和倾向评分匹配数据比较两组患者的院内死亡率、主要不良事件发生率、住院时间、护理费用及中间护理机构利用率。
结果
透析患者主动脉瓣置换术的使用率增加了3倍；2005年至2014年间共识别出2531例接受SAVR（n = 2264）或TAVR（n = 267）的透析患者。倾向评分匹配产生197对匹配病例。匹配后，发现SAVR患者的院内死亡率比TAVR患者增加了1倍（13.7%对6.1%，P = 0.021）。接受TAVR的患者永久性起搏器植入率更高（13.2%对5.6%，P = 0.012），但输血率更低（43.7%对56.8%，P = 0.02）。其他关键发病率相似。SAVR患者的住院时间（19±16天对11±11天，P<0.001）和非回家出院率（44.7%对31.5%，P = 0.002）显著更高。TAVR的住院费用低25%。
结论
在维持性透析患者中，与SAVR相比，TAVR与更低的院内死亡率、资源利用率及费用相关。
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