Ando Tomo, Akintoye Emmanuel, Telila Tesfaye, Briasoulis Alexandros, Takagi Hisato, Schreiber Theodore, Afonso Luis, Grines Cindy L
Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology, Detroit, Michigan.
Mayo Clinic, Division of Heart Failure, Rochester, Minnesota.
Catheter Cardiovasc Interv. 2018 Mar 1;91(4):813-819. doi: 10.1002/ccd.27362. Epub 2017 Oct 9.
To assess the in-hospital mortality and complications in female between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).
Female is one of the risk factors for increased adverse events in cardiac surgery.
Nationwide Inpatient Sample database was queried from 2011 to 2014 for patients who underwent TAVR or SAVR in female patients. The primary endpoint was in-hospital all-cause mortality and second endpoints were perioperative complications. We performed a propensity score analysis to calculate the adjusted odds ratio (OR) for each outcome. Patients who had concomitant cardiac surgery and those who had TAVR or SAVR mainly for aortic regurgitation were excluded. Our query from 2011 to 2014 resulted in a total of 3,067 TAVR and 18,594 SAVR in female patients. TAVR patients were in general elder and had a higher burden of comorbidities. The primary endpoint was similar between TAVR and SAVR (4.2% vs. 3.9%, OR 1.0, P = 0.89). Compared to SAVR, female TAVR patients had less hemorrhage requiring transfusion (12% vs. 21%, OR 0.41, P < 0.001), perioperative cardiac arrest and nonfatal myocardial infarction (9.8% vs. 17%, OR 0.38, P < 0.001), respiratory complication (1.6% vs. 4.4%, OR 0.28, P < 0.001), post-op sepsis (1.7% vs. 2.9%, OR 0.65, P = 0.03), acute myocardial infarction (3.0% vs. 4.9%, OR 0.60, P < 0.001), and acute kidney injury (15% vs. 18%, OR 0.62, P < 0.001). Conversely, female TAVR patients had significantly increased risk of new pacemaker implantation (11% vs. 5.9%, OR 1.7, P < 0.001) and use of extracorporeal membrane oxygenation (0.66% vs. 0.24%, OR 2.8, P < 0.001). TAVR patients had less nonroutine discharge. The median hospital cost was significantly higher in TAVR than SAVR (median $51,274 vs. $43,677, P < 0.001) but the length of stay was shorter (mean 7.8 days vs. 10.5 days).
TAVR may be a better option for those patients with underlying comorbidities that predispose them at higher risk for complications that was less observed in TAVR group. However, higher cost and increased risk of need for extracorporeal membrane oxygenation, although rare, should be taken into consideration upon deciding the optimal mode for aortic valve replacement.
评估经导管主动脉瓣置换术（TAVR）与外科主动脉瓣置换术（SAVR）治疗女性患者时的院内死亡率及并发症情况。
女性是心脏手术中不良事件增加的危险因素之一。
查询2011年至2014年全国住院患者样本数据库中接受TAVR或SAVR治疗的女性患者。主要终点为院内全因死亡率，次要终点为围手术期并发症。我们进行倾向评分分析以计算各结局的调整比值比（OR）。排除同期进行心脏手术以及主要因主动脉瓣反流接受TAVR或SAVR治疗的患者。我们对2011年至2014年的查询结果显示，共有3067例女性患者接受TAVR治疗，18594例女性患者接受SAVR治疗。TAVR患者总体年龄较大，合并症负担较重。TAVR与SAVR的主要终点相似（4.2%对3.9%，OR 1.0，P = 0.89）。与SAVR相比，接受TAVR治疗的女性患者需要输血的出血情况较少（12%对21%，OR 0.41，P < 0.001），围手术期心脏骤停和非致命性心肌梗死较少（9.8%对17%，OR 0.38，P < 0.001），呼吸并发症较少（1.6%对4.4%，OR 0.28，P < 0.001），术后脓毒症较少（1.7%对2.9%，OR 0.65，P = 0.03），急性心肌梗死较少（3.0%对4.9%，OR 0.60，P < 0.001），急性肾损伤较少（15%对18%，OR 0.62，P < 0.001）。相反，接受TAVR治疗的女性患者植入新起搏器的风险显著增加（11%对5.9%，OR 1.7，P < 0.001），使用体外膜肺氧合的情况增加（0.66%对0.24%，OR 2.8，P < 0.001）。TAVR患者非常规出院情况较少。TAVR的中位住院费用显著高于SAVR（中位51274美元对43677美元，P < 0.001），但住院时间较短（平均7.8天对10.5天）。
对于那些存在基础合并症、并发症风险较高的患者，TAVR可能是更好的选择，TAVR组中此类情况较少见。然而，在决定主动脉瓣置换的最佳方式时，应考虑到较高的费用以及体外膜肺氧合需求增加的风险，尽管这种情况很少见。
