Gassa Asmae, Borghardt Jan H, Maier Johanna, Kuhr Kathrin, Michel Maximilian, Ney Svenja, Eghbalzadeh Kaveh, Sabashnikov Anton, Rudolph Tanja, Baldus Stephan, Mader Navid, Wahlers Thorsten
Department of Cardiothoracic Surgery, Heartcenter, Heartcenter, University of Cologne, Cologne, Germany.
School of Medicine, Medical Faculty, Heartcenter, University of Cologne, Cologne, Germany.
J Thorac Dis. 2018 Dec;10(12):6763-6770. doi: 10.21037/jtd.2018.11.30.
Patients undergoing transcatheter aortic valve replacement (TAVR) are mostly elderly patients with substantial comorbidities. Established risk scores are not validated for TAVR and collectives with elderly patients making periprocedural risk stratification difficult. Serum albumin is known to be an indicator for malnutrition and frailty and is simple to measure, independent of physician's bias. Using serum albumin as a preoperative marker for postoperative complications might help estimating morbidity and mortality of these patients.
A total of 457 patients with severe symptomatic aortic stenosis undergoing TAVR at our institution in a period from January 2014 to December 2015 were included in this retrospective study. Baseline characteristics as well as preoperative laboratory parameters were registered. Postoperative morbidity and 30-day mortality were analyzed as primary end points. Enrolled patients with preoperative low serum albumin (<3.5 g/dL) were compared with those revealing normal serum albumin (≥3.5 g/dL).
Among 457 patients, 51 (11%) presented pre-procedural low serum albumin and 406 (89%) had normal serum albumin. Patients' mean age was 81±6 years and 50% of them were male. Postoperative complications such as requirement of blood transfusions (63% versus 33%, P<0.001), infection (53% versus 24%, P<0.001), acute kidney injury (41% versus 19%, P=0.001) and 30-day mortality (10% versus 3%, P=0.045) showed significant differences between preoperative low and normal albumin groups.
Preoperative low serum albumin might be an indicator for higher morbidity and mortality in patients undergoing TAVR.
接受经导管主动脉瓣置换术（TAVR）的患者大多是患有多种合并症的老年患者。现有的风险评分未在TAVR中得到验证，且老年患者群体使得围手术期风险分层变得困难。血清白蛋白已知是营养不良和虚弱的指标，且测量简单，不受医生偏见影响。将血清白蛋白用作术后并发症的术前标志物可能有助于评估这些患者的发病率和死亡率。
本回顾性研究纳入了2014年1月至2015年12月期间在我院接受TAVR的457例有严重症状性主动脉瓣狭窄的患者。记录基线特征以及术前实验室参数。将术后发病率和30天死亡率作为主要终点进行分析。将术前血清白蛋白低（<3.5 g/dL）的入选患者与血清白蛋白正常（≥3.5 g/dL）的患者进行比较。
在457例患者中，51例（11%）术前血清白蛋白低，406例（89%）血清白蛋白正常。患者的平均年龄为81±6岁，其中50%为男性。术前低白蛋白组和正常白蛋白组在术后并发症如输血需求（63%对33%，P<0.001）、感染（53%对24%，P<0.001）、急性肾损伤（41%对19%，P=0.001）和30天死亡率（10%对3%，P=0.045）方面存在显著差异。
术前血清白蛋白低可能是TAVR患者发病率和死亡率较高的一个指标。
