Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
Open Heart. 2020 Dec;7(2). doi: 10.1136/openhrt-2020-001467.
Patients' backgrounds and clinical outcomes in urgent/emergent/salvage transcatheter aortic valve replacement (Em-TAVR) remain unclear. We investigated patient characteristics and the mortality in Em-TAVR and the predictors for the need for Em-TAVR.
We consecutively enrolled 1613 patients undergoing TAVR for severe aortic stenosis between October 2013 and July 2016 from the Optimised transCathEter vAlvular interventioN (OCEAN)-transcatheter aortic valve implantation (TAVI) registry. The urgency was based on the European System for Cardiac Operative Risk Evaluation II. Urgent, emergent or salvage were included with the Em-TAVR group and elective with the El-TAVR group.
Em-TAVR was observed in 87 (5.4%) patients. A higher Clinical Frailty Scale (CFS), peripheral artery disease (PAD), hypoalbuminaemia, reduced left ventricular ejection fraction (LVEF) and preoperative at least moderate mitral regurgitation (MR) predicted the need for the Em-TAVR by the multivariate logistic regression analysis. The Em-TAVR group had the higher Society of Thoracic Surgeons Score (13.7 (IQR 8.2-21.0) vs 6.5 (IQR 4.6-9.2); p<0.001) and higher 30-day mortality (9.2% vs 1.3%; p<0.001) than the El-TAVR group. Accordingly, Kaplan-Meier analysis showed that the cumulative mortality was higher in the Em-TAVR group than that in the El-TAVR group (log-rank; p<0.001). However, Em-TAVR did not predict mortality in the multivariate Cox regression analysis.
Em-TAVR was performed in 5.4% of patients. Higher CFS, PAD, hypoalbuminaemia, reduced LVEF and preprocedural MR predicted the need for Em-TAVR. Em-TAVR was not a predictor for mortality in the multivariate analysis, suggesting that it is a reasonable treatment option.
紧急/急诊/抢救经导管主动脉瓣置换术（Em-TAVR）患者的背景和临床结局尚不清楚。我们研究了 Em-TAVR 患者的特征和死亡率，以及需要 Em-TAVR 的预测因素。
我们连续纳入了 2013 年 10 月至 2016 年 7 月期间因严重主动脉瓣狭窄在 Optimised transCathEter vAlvular interventioN（OCEAN）-经导管主动脉瓣植入术（TAVI）注册中心接受 TAVR 的 1613 例患者。紧急情况基于欧洲心脏手术风险评估系统 II。紧急、急诊或抢救的患者纳入 Em-TAVR 组，择期的患者纳入 El-TAVR 组。
Em-TAVR 见于 87 例（5.4%）患者。多变量逻辑回归分析显示，较高的临床虚弱评分（CFS）、外周动脉疾病（PAD）、低白蛋白血症、左心室射血分数（LVEF）降低和术前至少中度二尖瓣反流（MR）预测需要 Em-TAVR。Em-TAVR 组的胸外科医生协会评分较高（13.7（IQR 8.2-21.0）比 El-TAVR 组的 6.5（IQR 4.6-9.2）；p<0.001），30 天死亡率较高（9.2%比 1.3%；p<0.001）。相应地，Kaplan-Meier 分析显示 Em-TAVR 组的累积死亡率高于 El-TAVR 组（对数秩；p<0.001）。然而，多变量 Cox 回归分析显示 Em-TAVR 不是死亡率的预测因素。
Em-TAVR 见于 5.4%的患者。较高的 CFS、PAD、低白蛋白血症、LVEF 降低和术前 MR 预测需要 Em-TAVR。在多变量分析中，Em-TAVR 不是死亡率的预测因素，表明这是一种合理的治疗选择。
