Worldwide Network of Innovation In Clinical Education and Research (WNICER) Institute, One Rockefeller Plaza, 11th Floor, New York, NY 10020 USA.
J Invasive Cardiol. 2020 Aug;32(8):302-309. doi: 10.25270/jic/20.00031.
To compare patient-level risk assessment at Veterans Affairs (VA) hospitals in patients undergoing transcatheter aortic valve replacement (TAVR) with patients included in the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) registry.
We retrospectively analyzed the outcomes of veterans with severe aortic stenosis (AS) receiving TAVR from 2012-2016 at eight VA hospitals and compared them with TVT registry outcomes from 2012-2015. Patients were identified via administrative data. Univariable and multivariable Cox proportional hazards models were used to examine 30-day and 1-year all-cause mortality, 30-day and 1-year transient ischemic attack/stroke rates, and permanent pacemaker (PPM) implantation rates.
During the study period, a total of 726 veterans underwent TAVR including valve-in-valve procedures (n = 50). Patients were predominantly male (98.2%), with mean age of 78.5 ± 9.3 years; 49.1% were at prohibitive risk and 12.1% were at high risk for surgical aortic valve replacement; 30-day and 1-year all-cause mortality rates were 2.5% and 14.7%, respectively; 30-day and 1-year combined TIA/stroke rates were 6.5% and 13.5%, respectively. In the TVT registry, 15.8% and 37.8% of patients were at prohibitive and high risk, respectively; 30-day and 1-year mortality rates were 5.7% and 22.7%, respectively, and stroke rates were 2.1% and 4.0%, respectively.
This report on TAVR risk assessment within the VA system demonstrates that despite a large proportion of patients classified as prohibitive risk, TAVR was associated with favorable 30-day and 1-year all-cause mortality rates when compared with published outcomes from the STS/ACC TVT registry.
比较退伍军人事务部 (VA) 医院接受经导管主动脉瓣置换术 (TAVR) 的患者与美国胸外科医师学会/美国心脏病学会经导管瓣膜治疗 (STS/ACC TVT) 登记处纳入的患者的患者水平风险评估。
我们回顾性分析了 2012 年至 2016 年在 8 家 VA 医院接受 TAVR 的严重主动脉瓣狭窄 (AS) 退伍军人的结局，并将其与 2012 年至 2015 年 TVT 登记处的结局进行了比较。患者通过行政数据进行识别。使用单变量和多变量 Cox 比例风险模型来检查 30 天和 1 年全因死亡率、30 天和 1 年短暂性脑缺血发作/卒中发生率和永久性起搏器 (PPM) 植入率。
在研究期间，共有 726 名退伍军人接受了 TAVR，包括瓣中瓣手术 (n = 50)。患者主要为男性 (98.2%)，平均年龄为 78.5 ± 9.3 岁；49.1%为禁忌风险，12.1%为外科主动脉瓣置换的高危风险；30 天和 1 年全因死亡率分别为 2.5%和 14.7%；30 天和 1 年联合 TIA/卒中发生率分别为 6.5%和 13.5%。在 TVT 登记处，15.8%和 37.8%的患者分别为禁忌和高危风险；30 天和 1 年死亡率分别为 5.7%和 22.7%，卒中发生率分别为 2.1%和 4.0%。
本报告介绍了 VA 系统内的 TAVR 风险评估，尽管很大一部分患者被归类为禁忌风险，但与 STS/ACC TVT 登记处公布的结果相比，TAVR 与 30 天和 1 年全因死亡率的良好结果相关。
