Department of Cardiology, Normandie Université, UNIROUEN, Rouen University Hospital, INSERM U1096, Rouen, France.
Department of Cardiology, Normandie Université, UNIROUEN, Rouen University Hospital, INSERM U1096, Rouen, France.
JACC Cardiovasc Interv. 2017 Dec 11;10(23):2426-2436. doi: 10.1016/j.jcin.2017.09.010.
The aim of this study was to assess the incidence, prognostic impact, and predictive factors of readmission for congestive heart failure (CHF) in patients with severe aortic stenosis treated by transcatheter aortic valve replacement (TAVR).
TAVR is indicated in patients with severe symptomatic aortic stenosis in whom surgery is considered high risk or is contraindicated. Readmission for CHF after TAVR remains a challenge, and data on prognostic and predictive factors are lacking.
All patients who underwent TAVR from January 2010 to December 2014 were included. Follow-up was achieved for at least 1 year and included clinical and echocardiographic data. Readmission for CHF was analyzed retrospectively.
This study included 546 patients, 534 (97.8%) of whom were implanted with balloon-expandable valves preferentially via the transfemoral approach in 87.8% of cases. After 1 year, 285 patients (52.2%) had been readmitted at least once, 132 (24.1%) for CHF. Patients readmitted for CHF had an increased risk for death (p < 0.0001) and cardiac death (p < 0.0001) compared with those not readmitted for CHF. On multivariate analysis, aortic mean gradient (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.79 to 0.99; p = 0.03), post-procedural blood transfusion (HR: 2.27; 95% CI: 1.13 to 5.56; p = 0.009), severe post-procedural pulmonary hypertension (HR: 1.04; 95% CI: 1.00 to 1.07; p < 0.0001), and left atrial diameter (HR: 1.47; 95% CI: 1.08 to 2.01; p = 0.02) were independently associated with CHF readmission at 1 year.
Readmission for CHF after TAVR was frequent and was strongly associated with 1-year mortality. Low gradient, persistent pulmonary hypertension, left atrial dilatation, and transfusions were predictive of readmission for CHF.
本研究旨在评估经导管主动脉瓣置换术（TAVR）治疗严重主动脉瓣狭窄患者因充血性心力衰竭（CHF）再入院的发生率、预后影响和预测因素。
TAVR 适用于手术风险高或禁忌的严重有症状主动脉瓣狭窄患者。TAVR 后因 CHF 再次入院仍然是一个挑战，缺乏关于预后和预测因素的数据。
纳入 2010 年 1 月至 2014 年 12 月期间接受 TAVR 的所有患者。至少随访 1 年，包括临床和超声心动图数据。回顾性分析因 CHF 再入院的情况。
本研究共纳入 546 例患者，其中 534 例（97.8%）优先经股动脉入路植入球囊扩张瓣膜，其中 87.8%的患者采用该方法。1 年后，285 例患者（52.2%）至少再入院一次，其中 132 例（24.1%）因 CHF 再入院。与未因 CHF 再入院的患者相比，因 CHF 再入院的患者死亡风险（p<0.0001）和心脏性死亡风险（p<0.0001）增加。多变量分析显示，主动脉平均梯度（风险比[HR]：0.88；95%置信区间[CI]：0.79 至 0.99；p=0.03）、术后输血（HR：2.27；95%CI：1.13 至 5.56；p=0.009）、严重术后肺动脉高压（HR：1.04；95%CI：1.00 至 1.07；p<0.0001）和左心房直径（HR：1.47；95%CI：1.08 至 2.01；p=0.02）与 1 年时因 CHF 再入院独立相关。
TAVR 后因 CHF 再入院较为常见，与 1 年死亡率密切相关。低梯度、持续性肺动脉高压、左心房扩张和输血与 CHF 再入院相关。
