Centre for Patient-centered Heart and Lung research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.
KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
Int J Cardiol. 2018 Oct 1;268:85-91. doi: 10.1016/j.ijcard.2018.05.026. Epub 2018 May 18.
The 30-day all-cause readmission rate after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) vary substantially. We conducted a systematic review and meta-analysis to examine the overall incidence, causes, and risk factors of 30-day all-cause readmission rate after SAVR and TAVR.
Eight medical research databases were searched; Cochrane, Medline, Embase, UpToDate, PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study.
Thirty-three articles were included in the systematic review, 32 of which were appropriate for the meta-analysis. Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95% CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart failure, arrhythmia, infection, and respiratory problems were the most frequent causes of all-cause readmission after SAVR and TAVR. Most frequent reported prior risk factors for all-cause readmission following TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary disease, atrial fibrillation, kidney problems, and transapical approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause readmission were reported in the literature to date.
In conclusion, the overall proportion of 30-day all-cause readmission after SAVR and TAVR are high. Interventions to prevent avoidable readmissions ought to be developed and implemented.
主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）后的 30 天全因再入院率差异很大。我们进行了系统评价和荟萃分析，以检查 SAVR 和 TAVR 后 30 天全因再入院率的总体发生率、原因和危险因素。
我们检索了 8 个医学研究数据库；Cochrane、Medline、Embase、UpToDate、PROSPERO、国家指南清除中心、SweMed 和 Oria。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）进行这项研究。
33 篇文章被纳入系统评价，其中 32 篇适合荟萃分析。总体而言，SAVR 组中有 17%（95%CI：16-18%）的患者和 TAVR 组中有 16%（95%CI：15-18%）的患者在 30 天内再次入院。心力衰竭、心律失常、感染和呼吸问题是 SAVR 和 TAVR 后全因再入院的最常见原因。TAVR 后全因再入院最常报道的先前危险因素是糖尿病、慢性肺部疾病/慢性阻塞性肺疾病、心房颤动、肾脏问题和经心尖途径/非股动脉入路。对于 SAVR，迄今为止，文献中没有报道 30 天全因再入院的危险因素。
总之，SAVR 和 TAVR 后 30 天全因再入院的总体比例较高。应当制定和实施预防可避免再入院的干预措施。
