Hall Philip S, O'Donnell Colin I, Mathew Verghese, Garcia Santiago, Bavry Anthony A, Banerjee Subhash, Jneid Hani, Denktas Ali E, Giacomini John C, Grossman Paul M, Aggarwal Kul, Zimmet Jeffrey M, Tseng Elaine E, Gozdecki Leo, Burke Lucas, Bertog Stefan C, Buchbinder Maurice, Plomondon Mary E, Waldo Stephen W, Shunk Kendrick A
University of North Carolina Rex Healthcare, Raleigh, North Carolina.
University of Colorado and Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
JACC Cardiovasc Interv. 2019 Nov 11;12(21):2186-2194. doi: 10.1016/j.jcin.2019.04.040. Epub 2019 Aug 28.
This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days.
Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers.
Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization.
Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). Nonfemoral access (odds ratio: 1.74; 95% confidence interval [CI]: 1.10 to 2.74), heart failure (odds ratio: 2.51; 95% CI: 1.83 to 3.44), and atrial fibrillation (odds ratio: 1.40; 95% CI: 1.01 to 1.95) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63).
Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.
本研究旨在描述在美国退伍军人事务部（VA）医疗中心接受经导管主动脉瓣置换术（TAVR）的退伍军人的临床和手术特征，并探讨这些特征与短期和长期死亡率、住院时间（LOS）以及30天内再入院情况的关联。
患有严重主动脉瓣狭窄的退伍军人经常在VA医疗中心接受TAVR。
纳入2012年至2017年间连续接受TAVR的退伍军人。患者和手术特征来自VA临床评估、报告和跟踪系统。主要结局为30天和1年生存率、住院时间>6天以及30天内再入院情况。进行逻辑回归和Cox比例风险分析以评估术前特征与住院时间和再入院之间的关联。
在研究期间，959名退伍军人在8个VA中心接受了TAVR，其中860例（90%）经股动脉入路，50例（5%）经心尖入路，36例（3.8%）经腋动脉入路，3例（0.3%）经主动脉入路。男性占主导（959例中的939例[98%]），平均年龄为78.1岁。30天内有28例死亡（2.9%），1年时有134例死亡（14.0%）。中位住院时间为5天，141名退伍军人在30天内再次入院（14.7%）。非股动脉入路（比值比：1.74；95%置信区间[CI]：1.10至2.74）、心力衰竭（比值比：2.51；95%CI：1.83至3.44）和心房颤动（比值比：1.40；95%CI：1.01至1.95）与住院时间延长相关。心房颤动与30天再入院相关（风险比：1.79；95%CI：1.22至2.63）。
在VA中心接受TAVR的退伍军人主要是患有严重合并症的老年男性。30天死亡率和再入院率以及1年死亡率的临床结局与VA以外的基准结局数据相比具有优势。
