Daily Joshua A, Tang Xinyu, Angtuaco Michael, Bolin Elijah, Lang Sean M, Collins R Thomas
Arkansas Children's Hospital, Little Rock, Arkansas; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Arkansas Children's Hospital, Little Rock, Arkansas; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Am J Cardiol. 2018 Aug 1;122(3):498-504. doi: 10.1016/j.amjcard.2018.04.028. Epub 2018 May 1.
Transcatheter pulmonary valve replacement (TC-PVR) is an alternative to surgical PVR (S-PVR) in repaired Tetralogy of Fallot (TOF). The purpose of this study is to compare in-hospital outcomes, hospital costs, and projected 5-year total costs of S-PVR to TC-PVR in patients with repaired TOF. We performed a multicenter, retrospective cohort study of children and adults with TOF ≥ 8 years of age who underwent PVR from January 1, 2010 to December 31, 2016 at 46 centers contributing to the Pediatric Health Information Systems database. Baseline characteristics, in-hospital outcomes, and costs were compared between the two groups. Projected 5-year costs were calculated by combining cost data with published reintervention rates. A total of 194 TC-PVR and 1,072 S-PVR were performed. The baseline characteristics of the TC-PVR and S-PVR groups were not significantly different with the exception of greater age in the TC-PVR group (median age of 17 years vs 15 years, p value <0.001). Discharge mortality, hospital charges and estimated cost, surgical complication rates, and acute kidney failure were not significantly different between the groups. Intensive care unit use, intensive care unit length of stay (LOS), mechanical ventilation use, extracorporeal membrane oxygenation use, and total LOS were lower with TC-PVR than S-PVR. Projected 5-year costs were greater with TC-PVR compared with S-PVR ($64,762 vs $56,536) due to the cost of the transcatheter pulmonary valve and higher reintervention rates. In conclusion, despite longer LOS and greater in-hospital resource utilization for patients with TOF who underwent S-PVR compared with TC-PVR, mortality, and in-hospital costs are the same, and projected 5-year costs are less.
经导管肺动脉瓣置换术（TC-PVR）是法洛四联症（TOF）修复术后外科肺动脉瓣置换术（S-PVR）的一种替代方案。本研究的目的是比较TOF修复术后患者接受S-PVR和TC-PVR的住院结局、住院费用以及预计的5年总成本。我们对2010年1月1日至2016年12月31日期间在46个向儿科健康信息系统数据库提供数据的中心接受肺动脉瓣置换术的8岁及以上TOF患儿和成人进行了一项多中心回顾性队列研究。比较了两组的基线特征、住院结局和费用。通过将成本数据与已公布的再次干预率相结合来计算预计的5年成本。共进行了194例TC-PVR和1072例S-PVR。TC-PVR组和S-PVR组的基线特征除TC-PVR组年龄较大外（中位年龄17岁对15岁，p值<0.001）无显著差异。两组之间的出院死亡率、住院费用和估计成本、手术并发症发生率以及急性肾衰竭无显著差异。TC-PVR组的重症监护病房使用情况、重症监护病房住院时间（LOS）、机械通气使用情况、体外膜肺氧合使用情况以及总住院时间均低于S-PVR组。由于经导管肺动脉瓣的成本和较高的再次干预率，TC-PVR组的预计5年成本高于S-PVR组（64,762美元对56,536美元）。总之，尽管与TC-PVR相比，接受S-PVR的TOF患者住院时间更长且住院资源利用率更高，但死亡率和住院费用相同，且预计5年成本更低。
