Kawasaki Saiwai Hospital, Division of Cardiology, Kawasaki, Kanagawa, Japan.
Wayne State University/Detroit Medical Center, Detroit, MI, United States.
Int J Cardiol. 2021 Feb 15;325:115-120. doi: 10.1016/j.ijcard.2020.10.038. Epub 2020 Oct 22.
Outcomes of redo aortic valve intervention (AVI) following transcatheter aortic valve replacement (TAVR) have not been well described. We thought to investigate the incidence, predictors, and outcomes of redo AVI after TAVR.
The Nationwide Readmission Database (from 2012 to 2017) was queried to identify admissions for TAVR. Redo AVI was defined as readmissions that required either TAVR or balloon aortic valvuloplasty (BAV) or surgical aortic valve replacement (SAVR). A multivariable regression model was used to identify independent predictors of redo AVI. In-hospital outcomes of redo TAVR or BAV and redo SAVR were compared in the unadjusted model.
A total of weighted 148,200 (unweighted redo AVI 297, no redo AVI 73,804) index TAVRs were identified. A weighted 593 (435 TAVR or BAV and 158 SAVR) redo AVI was included with an incidence of 1.0 per 100 person-year during a median of 105 (interquartile range 41-195) days follow-up. Predictors of redo AVI were female, heart failure, obesity, atrial fibrillation, transapical approach, oral anticoagulant use, and acute kidney injury. In-hospital mortality of redo AVI was 7.6% (5.3% for redo TAVR or BAV vs. 13.8% for redo SAVR, unadjusted p = 0.10). Stroke, myocardial infarction, bleeding requiring transfusion, new pacemaker, and acute kidney injury rates were 4.7%, 2.6%, 9.3%, 10.0%, and 31.2%, respectively in redo AVI. Length of stay and hospital cost was 4.8 days and 55,826 U.S. dollars, respectively.
The incidence of redo AVI was low following TAVR but was associated with high mortality and morbidities.
经导管主动脉瓣置换术（TAVR）后再次主动脉瓣干预（AVI）的结果尚未得到很好的描述。我们试图研究 TAVR 后再次 AVI 的发生率、预测因素和结果。
从 2012 年至 2017 年，查询全国再入院数据库（Nationwide Readmission Database）以确定 TAVR 入院人数。再次 AVI 定义为需要 TAVR、球囊主动脉瓣成形术（BAV）或外科主动脉瓣置换术（SAVR）的再入院。使用多变量回归模型确定再次 AVI 的独立预测因素。在未调整模型中比较再次 TAVR 或 BAV 和再次 SAVR 的住院期间结局。
共确定了 148200 例加权指数 TAVR（未加权再次 AVI 297 例，无再次 AVI 73804 例）。在中位时间为 105（四分位距 41-195）天的随访中，纳入了 593 例（435 例 TAVR 或 BAV 和 158 例 SAVR）加权再次 AVI，发生率为每 100 人年 1.0 例。再次 AVI 的预测因素为女性、心力衰竭、肥胖、心房颤动、经心尖途径、口服抗凝剂使用和急性肾损伤。再次 AVI 的住院死亡率为 7.6%（再次 TAVR 或 BAV 为 5.3%，再次 SAVR 为 13.8%，未调整 p=0.10）。再次 AVI 的卒中和心肌梗死发生率分别为 4.7%和 2.6%，出血需要输血的发生率为 9.3%，新安装起搏器的发生率为 10.0%，急性肾损伤发生率为 31.2%。再次 AVI 的住院时间和住院费用分别为 4.8 天和 55826 美元。
TAVR 后再次 AVI 的发生率较低，但与高死亡率和高发病率相关。
