From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., C.C.T., G.W., M.J.G.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K., I.I., S.E.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.,); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (A.K.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F); Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (N.S.K.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
Circ Cardiovasc Interv. 2018 Apr;11(4):e006179. doi: 10.1161/CIRCINTERVENTIONS.117.006179.
A significant proportion of patients requiring aortic valve replacement (AVR) have undergone prior coronary artery bypass grafting (CABG). Reoperative heart surgery is associated with increased risk. Data on relative utilization and comparative outcomes of transcatheter (TAVR) versus surgical AVR (SAVR) in patients with prior CABG are limited.
We queried the 2012 to 2014 National Inpatient Sample databases to identify isolated AVR hospitalizations in adults with prior CABG. In-hospital outcomes of TAVR versus SAVR were compared using propensity-matched analysis. Of 147 395 AVRs, 15 055 (10.2%) were in patients with prior CABG. The number of TAVRs in patients with prior CABG increased from 1615 in 2012 to 4400 in 2014, whereas the number of SAVRs decreased from 2285 to 1895 (<0.001). There were 3880 records in each group in the matched cohort. Compared with SAVR, TAVR was associated with similar in-hospital mortality (2.3% versus 2.4%; =0.71) but lower incidence of myocardial infarction (1.5% versus 3.4%; <0.001), stroke (1.4% versus 2.7%; <0.001), bleeding complications (10.6% versus 24.6%; <0.001), and acute kidney injury (16.2% versus 19.3%; <0.001). Requirement for prior permanent pacemaker was higher in the TAVR cohort, whereas the incidence of vascular complications and acute kidney injury requiring dialysis was similar in the 2 groups. Average length of stay was shorter in patients undergoing TAVR.
TAVR is being increasingly used as the preferred modality of AVR in patients with prior CABG. Compared with SAVR, TAVR is associated with similar in-hospital mortality but lower rates of in-hospital complications in this important subset of patients.
相当一部分需要主动脉瓣置换术（AVR）的患者曾接受过冠状动脉旁路移植术（CABG）。再次心脏手术的风险增加。关于先前 CABG 患者经导管（TAVR）与外科 AVR（SAVR）的相对利用和比较结果的数据有限。
我们查询了 2012 年至 2014 年国家住院患者样本数据库，以确定先前 CABG 的成人中孤立性 AVR 住院患者。使用倾向匹配分析比较 TAVR 与 SAVR 的住院期间结局。在 147395 例 AVR 中，有 15055 例（10.2%）发生在先前 CABG 的患者中。先前 CABG 患者的 TAVR 数量从 2012 年的 1615 例增加到 2014 年的 4400 例，而 SAVR 数量从 2285 例减少到 1895 例（<0.001）。匹配队列中每组各有 3880 条记录。与 SAVR 相比，TAVR 的院内死亡率相似（2.3%比 2.4%；=0.71），但心肌梗死发生率较低（1.5%比 3.4%；<0.001）、中风（1.4%比 2.7%；<0.001）、出血并发症（10.6%比 24.6%；<0.001）和急性肾损伤（16.2%比 19.3%；<0.001）。TAVR 组需要先前的永久性起搏器的比例较高，而两组血管并发症和需要透析的急性肾损伤的发生率相似。TAVR 组患者的平均住院时间较短。
TAVR 作为先前 CABG 患者 AVR 的首选方式越来越被广泛应用。与 SAVR 相比，TAVR 与这一重要患者亚群的院内死亡率相似，但院内并发症发生率较低。
