Jou Stephanie, Patel Hiren, Oglat Hamza, Zhang Robert, Zhang Li, Ells Peter, Nappi Anthony, El-Hajjar Mohammad, DeLago Augustin, Torosoff Mikhail
Division of Cardiology, Albany Medical College/Albany Medical Center, Albany, NY, USA.
Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, 622 West 168th Street, Floor 2, New York, NY, 10032, USA.
Heart Vessels. 2020 Aug;35(8):1102-1108. doi: 10.1007/s00380-020-01588-y. Epub 2020 Mar 28.
Preoperative hyperbilirubinemia is associated with increased mortality and morbidity after cardiac surgery. However, this clinical significance is unclear with transcatheter aortic valve replacement (TAVR) procedures. The aims of this study were to determine the prevalence and prognostic implications of preoperative elevations of serum total bilirubin on TAVR outcomes. In 611 consecutive patients who underwent an elective TAVR procedure, 576 patients had recorded serum total bilirubin levels. Hyperbilirubinemia was defined as any value of serum total bilirubin ≥ 1.2 mg/dL obtained within 30-days prior to the TAVR procedure. The primary composite endpoint was post-TAVR all-cause in-hospital mortality or stroke. The overall prevalence of hyperbilirubinemia was 10% (n = 58). There were no patients with a prespecified diagnosis of liver cirrhosis. Pre-TAVR hyperbilirubinemia compared to normal bilirubin level was more common in younger (78 ± 10 vs. 82 ± 8 years old, p < 0.001) males (15 vs. 6%, p < 0.001), with history of pacemaker or ICD (33 vs. 18%, p = 0.005), congestive heart failure New York Heart Association class IV within 2 weeks from TAVR (35 vs. 14%, p < 0.001), severe tricuspid regurgitation (14 vs. 4%, p < 0.001), and atrial fibrillation or flutter (60 vs. 40%, p = 0.004, respectively). Pre-TAVR hyperbilirubinemia was independently associated with an increased post-TAVR in-hospital mortality (7 vs. 2% in normal bilirubin, p = 0.03), stroke (5 vs. 1%, p = 0.019, respectively), and a composite endpoint of death or stroke (12 vs. 3%, p < 0.001). Preoperative hyperbilirubinemia in patients undergoing TAVR is more prevalent than previously considered with multifactorial causes. Hyperbilirubinemia is independently associated with an increased post-TAVR in-hospital mortality and stroke.
术前高胆红素血症与心脏手术后死亡率和发病率增加相关。然而，经导管主动脉瓣置换术（TAVR）中这种临床意义尚不清楚。本研究的目的是确定术前血清总胆红素升高对TAVR结局的发生率及预后影响。在611例连续接受择期TAVR手术的患者中，576例患者记录了血清总胆红素水平。高胆红素血症定义为TAVR手术前30天内获得的血清总胆红素≥1.2mg/dL的任何值。主要复合终点是TAVR术后全因住院死亡率或卒中。高胆红素血症的总体发生率为10%（n = 58）。没有预先诊断为肝硬化的患者。与正常胆红素水平相比，TAVR术前高胆红素血症在年龄较小者（78±10岁 vs. 82±8岁，p < 0.001）、男性（15% vs. 6%，p < 0.001）、有起搏器或植入式心律转复除颤器（ICD）病史者（33% vs. 18%，p = 0.005）、TAVR术前2周内纽约心脏协会IV级充血性心力衰竭者（35% vs. 14%，p < 0.001）、严重三尖瓣反流者（14% vs. 4%，p < 0.001）以及心房颤动或心房扑动者（分别为60% vs. 40%，p = 0.004）中更常见。TAVR术前高胆红素血症与TAVR术后住院死亡率增加（正常胆红素者为2%，高胆红素血症者为7 %，p = 0.03）、卒中（正常胆红素者为1%，高胆红素血症者为5%，p = 0.019）以及死亡或卒中复合终点（正常胆红素者为3%，高胆红素血症者为12%，p < 0.001）独立相关。接受TAVR治疗的患者术前高胆红素血症比之前认为的更普遍，且病因多因素。高胆红素血症与TAVR术后住院死亡率和卒中增加独立相关。
