Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia.
Division of Cardiology, Department of Medicine, University of Kentucky, Lexington, Kentucky.
JACC Cardiovasc Interv. 2020 Mar 9;13(5):583-591. doi: 10.1016/j.jcin.2019.11.041. Epub 2020 Feb 12.
This study sought to use a national representative database to assess the incidence, predictors, and outcomes of balloon aortic valvuloplasty (BAV) as a bridge to transcatheter aortic valve replacement (TAVR) in contemporary practice.
Nationwide data on the use and outcomes of BAV as a bridge to TAVR are limited.
Patients who underwent BAV between January and June in 2015 and 2016 were identified in the National Readmission Database. We assessed rate of subsequent TAVR following BAV, and predictors and timing of subsequent TAVR. We then identified a group of patients who had direct TAVR (without prior BAV) in the original 2015 to 2016 National Readmission Database dataset. We compared in-hospital outcomes following TAVR between patients with prior bridging BAV and those undergoing direct TAVR.
Among the 3,691 included patients 1,426 (38.6%) had subsequent TAVR. Timing of TAVR was pre-discharge in 7.4%, within 30 days in 35%, between 31 and 90 days in 47%, between 91 and 180 days in 14%, and >180 days in 4%. Negative predictors of subsequent TAVR included prior defibrillator (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.36 to 0.85), dementia (OR: 0.60; 95% CI: 0.46 to 0.79), malnutrition (OR: 0.64; 95% CI: 0.45 to 0.90), and malignancy (OR: 0.62; 95% CI: 0.47 to 0.82). In propensity-score matched cohorts of patients who underwent direct TAVR versus those with prior BAV, in-hospital mortality during TAVR admission was similar (3.7% vs. 3.5%; p = 0.91). Major complications, length of stay, and discharge disposition were also comparable. However, cost of the hospitalization was higher in the direct TAVR group.
About 40% of BAV patients undergo subsequent TAVR mostly within 90 days. In-hospital outcomes of TAVR in these patients were comparable with propensity-score matched patients who underwent TAVR without prior BAV. Further investigations are needed to define the role of BAV in contemporary practice.
本研究旨在利用全国代表性数据库评估在当代实践中，经皮球囊主动脉瓣成形术（BAV）作为经导管主动脉瓣置换术（TAVR）桥接的发生率、预测因素和结果。
关于 BAV 作为 TAVR 桥接的使用和结果的全国数据有限。
在 2015 年 1 月至 6 月和 2016 年期间，国家再入院数据库中确定了接受 BAV 的患者。我们评估了 BAV 后随后进行 TAVR 的比率，以及随后进行 TAVR 的预测因素和时间。然后，我们在原始 2015 年至 2016 年国家再入院数据库数据集中确定了一组直接接受 TAVR（无先前 BAV）的患者。我们比较了有先前搭桥 BAV 的患者和直接接受 TAVR 的患者的 TAVR 后的住院期间结局。
在 3691 名纳入患者中，有 1426 名（38.6%）随后进行了 TAVR。TAVR 的时间为出院前 7.4%，30 天内 35%，31 至 90 天内 47%，91 至 180 天内 14%，>180 天内 4%。随后 TAVR 的负预测因素包括先前的除颤器（比值比 [OR]：0.56；95%置信区间 [CI]：0.36 至 0.85）、痴呆（OR：0.60；95%CI：0.46 至 0.79）、营养不良（OR：0.64；95%CI：0.45 至 0.90）和恶性肿瘤（OR：0.62；95%CI：0.47 至 0.82）。在直接接受 TAVR 与先前接受 BAV 的患者的倾向评分匹配队列中，TAVR 住院期间的院内死亡率相似（3.7% vs. 3.5%；p=0.91）。主要并发症、住院时间和出院去向也相似。然而，直接 TAVR 组的住院费用更高。
约 40%的 BAV 患者在 90 天内接受随后的 TAVR。这些患者的 TAVR 住院期间结局与接受无先前 BAV 的 TAVR 的倾向评分匹配患者相似。需要进一步研究来确定 BAV 在当代实践中的作用。
