Department of Medicine/Division of Cardiology, Rutgers University School of Medicine, Newark, New Jersey.
Department of Medicine/Division of Cardiology, Case Western Reserve University, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2018 Oct 1;92(4):757-765. doi: 10.1002/ccd.27433. Epub 2017 Nov 24.
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at intermediate and high risk for surgery. Commercial use of TAVR has expanded to patients with end stage renal disease (ESRD).
Compare in-hospital outcomes of TAVR versus SAVR in ESRD patients requiring hemodialysis (HD).
ESRD patients on HD undergoing TAVR (n = 328) or SAVR (n = 697) between 2012 and 2014 were identified in the National Inpatient Sample (NIS). Propensity-score matching method was used to minimize selection bias. Baseline characteristics and in-hospital outcomes were compared.
TAVR patients were older (75.3 vs. 61.6 years, P < 0.001) and had more comorbidities, including congestive heart failure (16.2% vs. 7.5%), diabetes mellitus (28.4% vs. 22.5%), chronic lung disease (27.7% vs. 20.4%), and peripheral vascular disease (35.1% vs. 21.2%). Propensity-score matching yielded 175 pairs of patients matched on 30 baseline covariates. Overall in-hospital mortality was high (9.9%) and similar between TAVR and SAVR (8% vs. 10.3%, P = 0.58). TAVR was associated with shorter length of stay (LOS) (8 vs. 14 days, P < 0.001), lower hospitalization cost ($276,448 vs. $364,280, P = 0.01), lower in-hospital complications (60.6% vs. 76%, P = 0.003), and higher rate of home discharge (31.4% vs. 17.7%, P = 0.004) compared with SAVR.
Regardless of treatment modality, patients with AS on HD have high in-hospital mortality. TAVR and SAVR have comparable in-hospital mortality in this population. However, TAVR is associated with shorter LOS, lower hospitalization costs, lower in-hospital complications, and higher rates of home discharge.
对于有严重症状性主动脉瓣狭窄（AS）且手术风险为中高危的患者，经导管主动脉瓣置换术（TAVR）是主动脉瓣置换术（SAVR）的替代方案。TAVR 的商业应用已扩展到终末期肾病（ESRD）患者。
比较 TAVR 与 ESRD 患者血液透析（HD）时 SAVR 的住院结局。
在 2012 年至 2014 年期间，国家住院患者样本（NIS）中确定了 328 例接受 TAVR 和 697 例接受 SAVR 的 ESRD 合并 HD 患者。采用倾向评分匹配法尽量减少选择偏倚。比较基线特征和住院结局。
TAVR 患者年龄较大（75.3 岁比 61.6 岁，P<0.001），合并症更多，包括充血性心力衰竭（16.2%比 7.5%）、糖尿病（28.4%比 22.5%）、慢性肺部疾病（27.7%比 20.4%）和外周血管疾病（35.1%比 21.2%）。倾向评分匹配得到了 175 对基于 30 个基线协变量匹配的患者。总体住院死亡率较高（9.9%），TAVR 和 SAVR 之间无差异（8%比 10.3%，P=0.58）。TAVR 与较短的住院时间（8 天比 14 天，P<0.001）、较低的住院费用（$276448 比 $364280，P=0.01）、较低的住院并发症发生率（60.6%比 76%，P=0.003）和更高的出院回家率（31.4%比 17.7%，P=0.004）相关。
无论治疗方式如何，HD 的 AS 患者的院内死亡率均较高。该人群中 TAVR 和 SAVR 的院内死亡率相当。然而，TAVR 与较短的住院时间、较低的住院费用、较低的院内并发症发生率和更高的出院回家率相关。
