Department of Medicine, West Virginia University, Morgantown, West Virginia, USA.
Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA.
Catheter Cardiovasc Interv. 2020 Oct 1;96(4):947-955. doi: 10.1002/ccd.28834. Epub 2020 Mar 4.
Even in high-risk trials pertaining to transcatheter aortic valve replacement (TAVR), patients with end-stage liver disease (ESLD) have been under-represented. We sought to study this population group from a large national United States population database.
We used National Inpatient Sample (NIS) database from January 2005 to August 2015. Patients with ESLD were extracted using Goldberg's algorithm. Propensity match analysis was done for comparative analysis between surgical aortic valve replacement (SAVR) and TAVR groups. Logistic regression analysis was used for predictors of in-hospital mortality.
Out of 309,959 ESLD patients, 1,375 underwent aortic valve replacement and 1,199 patients were included in our study. Mean age was 66.1 (SD, 9.1) years. In matched data, the in-hospital mortality was 5.5% in TAVR group when compared to 19.4% in SAVR group. Ventilator use (16.1 vs. 27.2%, p < .01), tracheostomy (<4 vs. 7.2%, p < .01), and vasopressin use (0 vs. 7.4%, p < .01) were utilized less in TAVR group as compared to SAVR group. The proportion of TAVR has increased from almost zero in 2011 to 51.3% in 2015. Mean cost for hospital stay has increased in SAVR group (from 254,427$ in 2005 to 321,791$ in 2015, p < .01). Similarly, a large decrease in length of stay has been observed for TAVR group (14.5 days in 2011 to 5.4 days in 2015, p < .01). TAVR (odds ratios [OR]: 0.42, 95% confidence interval [CI]: 0.20-0.87, p = .02) was associated with lower in-hospital mortality.
TAVR was associated with lower in-hospital mortality, morbidity, and resource utilization in high-risk ESLD patients.
即使在涉及经导管主动脉瓣置换术（TAVR）的高危试验中，终末期肝病（ESLD）患者的代表性也不足。我们试图从美国大型全国人口数据库中研究这一人群。
我们使用 2005 年 1 月至 2015 年 8 月的国家住院患者样本（NIS）数据库。使用 Goldberg 算法提取 ESLD 患者。对手术主动脉瓣置换术（SAVR）和 TAVR 组进行倾向匹配分析。使用逻辑回归分析预测住院死亡率的预测因子。
在 309959 例 ESLD 患者中，有 1375 例行主动脉瓣置换术，其中 1199 例纳入本研究。平均年龄为 66.1（SD，9.1）岁。在匹配数据中，TAVR 组的住院死亡率为 5.5%，而 SAVR 组为 19.4%。TAVR 组呼吸机使用率（16.1%比 27.2%，p<0.01）、气管切开术使用率（<4%比 7.2%，p<0.01）和血管加压素使用率（0%比 7.4%，p<0.01）均低于 SAVR 组。TAVR 的比例从 2011 年的几乎为零增加到 2015 年的 51.3%。SAVR 组的住院费用平均增加（从 2005 年的 254427 美元增加到 2015 年的 321791 美元，p<0.01）。同样，TAVR 组的住院时间也大幅缩短（从 2011 年的 14.5 天缩短至 2015 年的 5.4 天，p<0.01）。TAVR（比值比[OR]：0.42，95%置信区间[CI]：0.20-0.87，p=0.02）与较低的住院死亡率相关。
TAVR 与高危 ESLD 患者的较低住院死亡率、发病率和资源利用相关。
