Wu Jing, Li Chenguang, Zheng Yang, Tong Qian, Liu Quan, Cong Xiaoqiang, Lou Zhiyang, Zhang Mingyou
Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China.
Department of Cardiovascular Medicine, Zhongshan Hospital, Shanghai, China.
Front Cardiovasc Med. 2020 Dec 7;7:603834. doi: 10.3389/fcvm.2020.603834. eCollection 2020.
The aim of this study was to evaluate the temporal trends of transcatheter aortic valve replacement (TAVR) in severe aortic stenosis (AS) patients with atrial fibrillation (AF) and to compare the in-hospital outcomes between TAVR and surgical aortic valve replacement (SAVR) in patients with AF. Data comparing TAVR to SAVR in severe AS patients with AF are lacking. National inpatient sample database in the United States from 2012 to 2016 were queried to identify hospitalizations for severe aortic stenosis patients with AF who underwent isolated aortic valve replacement. A propensity score-matched analysis was used to compare in-hospital outcomes for TAVR vs. SAVR for AS patients with AF. The analysis included 278,455 hospitalizations, of which 124,910 (44.9%) were comorbid with AF. Before matching, TAVR had higher in-hospital mortality than SAVR (3.1 vs. 2.2%, < 0.001); however, there was a declining trend during the study period (Ptrend < 0.001). After matching, TAVR and SAVR had similar in-hospital mortality (2.9 vs. 2.9%, < 0.001) and stroke. TAVR was associated with lower rates of acute kidney injury, new dialysis, cardiac complications, acquired pneumonia, sepsis, mechanical ventilation, tracheostomy, non-routine discharge, and shorter length of stay; however, TAVR was associated with more pacemaker implantation and higher cost. Of the patients receiving TAVR, the presence of AF was associated with an increased rate of complications and increased medical resource usage compared to those without AF. In-hospital mortality and stroke for TAVR and SAVR in AF, AS are similar; however, the in-hospital mortality in TAVR AF is declining and associated with more favorable in-hospital outcomes.
本研究的目的是评估经导管主动脉瓣置换术（TAVR）在伴有心房颤动（AF）的严重主动脉瓣狭窄（AS）患者中的时间趋势，并比较AF患者中TAVR与外科主动脉瓣置换术（SAVR）的院内结局。缺乏在伴有AF的严重AS患者中比较TAVR与SAVR的数据。查询了2012年至2016年美国国家住院样本数据库，以确定接受单纯主动脉瓣置换术的伴有AF的严重主动脉瓣狭窄患者的住院情况。采用倾向评分匹配分析来比较AF的AS患者中TAVR与SAVR的院内结局。该分析包括278,455例住院病例，其中124,910例（44.9%）合并AF。匹配前，TAVR的院内死亡率高于SAVR（3.1%对2.2%，P<0.001）；然而，在研究期间呈下降趋势（P趋势<0.001）。匹配后，TAVR和SAVR的院内死亡率（2.9%对2.9%，P<0.001）和卒中相似。TAVR与急性肾损伤、新透析、心脏并发症、获得性肺炎、脓毒症、机械通气、气管切开术、非常规出院的发生率较低以及住院时间较短相关；然而，TAVR与更多起搏器植入和更高成本相关。在接受TAVR的患者中，与无AF的患者相比，AF的存在与并发症发生率增加和医疗资源使用增加相关。AF、AS患者中TAVR和SAVR的院内死亡率和卒中相似；然而，TAVR合并AF的院内死亡率正在下降，并与更有利的院内结局相关。
