Alkhouli Mohamad, Alqahtani Fahad, Ziada Khaled M, Aljohani Sami, Holmes David R, Mathew Verghese
Division of Cardiology, Department of Medicine, West Virginia University, 1 Medical Drive, Morgantown, WV 26505, USA.
Department of Cardiology, Mayo Clinic School of Medicine, 200 First St. SW Rochester, MN 55905, USA.
Eur Heart J. 2020 Feb 21;41(8):921-928. doi: 10.1093/eurheartj/ehz568.
To assess the contemporary trends in aortic stenosis (AS) interventions in the USA before and after the introduction of transcatheter aortic valve implantation (TAVI).
We utilized the National-Inpatient-Sample to assess temporal trends in the incidence, cost, and outcomes of AS interventions between 1 January 2003 and 31 December 2016. During the study's period, AS interventions increased from 96 to 137 per 100 000 individuals > 60 years old, P < 0.001. In-hospital expenditure on AS interventions increased from $2.28 billion in 2003 to $4.33 in 2016 P < 0.001. Among patients who underwent aortic valve replacement, the proportion of TAVI increased from 11.9% in 2012 to 43.2% in 2016 (P < 0.001). Males and Hispanics had lower proportions of TAVI compared with females and White patients. Adjusted in-hospital mortality of isolated SAVR decreased from 5.4% in 2003 to 3.3% in 2016 (P < 0.001), whereas adjusted in-hospital mortality of TAVI decreased from 4.7% in 2012 to 2.2% in 2016, P < 0.001. The incidence of new dialysis, permanent pacemaker implantation, and blood transfusion decreased after both TAVI and SAVR between 2012 and 2016. However, the rate of post-operative stroke did not significantly decrease. Length of stay and cost of hospitalization decreased after both SAVR and TAVI, although the later remained higher with TAVI. Rates of non-home discharge decreased over time after TAVI but remained stable after isolated SAVR.
This nationwide survey documents the increasing incidence of AS interventions, the rising cost of modern AS care, and the paradigm shift in aortic valve replacement practice in the USA.
评估经导管主动脉瓣植入术（TAVI）引入前后美国主动脉瓣狭窄（AS）干预措施的当代趋势。
我们利用全国住院患者样本评估2003年1月1日至2016年12月31日期间AS干预措施的发生率、成本和结局的时间趋势。在研究期间，60岁以上人群中AS干预措施的发生率从每10万人96例增加到137例，P<0.001。AS干预措施的住院费用从2003年的22.8亿美元增加到2016年的43.3亿美元，P<0.001。在接受主动脉瓣置换术的患者中，TAVI的比例从2012年的11.9%增加到2016年的43.2%（P<0.001）。与女性和白人患者相比，男性和西班牙裔患者接受TAVI的比例较低。单纯外科主动脉瓣置换术（SAVR）的校正住院死亡率从2003年的5.4%降至2016年的3.3%（P<0.001），而TAVI的校正住院死亡率从2012年的4.7%降至2016年的2.2%，P<0.001。2012年至2016年期间，TAVI和SAVR后新透析、永久性起搏器植入和输血的发生率均下降。然而，术后中风发生率并未显著下降。SAVR和TAVI后住院时间和住院费用均下降，尽管TAVI的住院时间和费用仍较高。TAVI后非回家出院率随时间下降，但单纯SAVR后保持稳定。
这项全国性调查记录了美国AS干预措施发生率的增加、现代AS治疗成本的上升以及主动脉瓣置换实践的模式转变。
