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经导管主动脉瓣置换术治疗肾和肝移植患者的临床结局:国家住院患者样本数据库分析。

Clinical outcomes of renal and liver transplant patients undergoing transcatheter aortic valve replacement: analysis of national inpatient sample database.

机构信息

Department of Medicine, Abington Jefferson Health, Abington, PA, USA.

Department of Medicine, Icahn School of Medicine at Mount Sinai Elmhurst, Elmhurst, Queens, NY, USA.

出版信息

Expert Rev Cardiovasc Ther. 2021 Apr;19(4):363-368. doi: 10.1080/14779072.2021.1892489. Epub 2021 Mar 4.

DOI:10.1080/14779072.2021.1892489
PMID:33615950
Abstract

The transcatheter aortic valve replacement (TAVR) has recently gained traction as a viable alternative to surgical aortic valve replacement (SAVR), but data on its safety and clinical outcomes in transplant patients are limited. We retrieved relevant demographic and clinical outcome data from the U.S. National Inpatient Sample (NIS) for the year 2012-2015. The clinical outcomes of TAVR in renal transplant (RT) and liver transplant (LT) were ascertained using an adjusted odds ratio (aOR) with a 95% confidence interval (CI) on Mantzel-Hensel test. A total of 62,399 TAVR patients were identified; 62,180 (99.6%) with no history of transplant, 219 (0.4%) with RT and 85 (0.1%) with LT. There was no significant difference in odds of in-hospital mortality (OR 0.61, 95% CI 0.25-1.5, p = 0.37), major cardiovascular, respiratory or neurological complications in patients with and without RT. Similarly, the odds of cardiac complications, renal and neurological complications between patients with and without LT were identical. Compared to non-transplant patients, TAVR appears to be associated with similar odds of major systemic complications or mortality in patients with a history of kidney or liver transplant.

摘要

经导管主动脉瓣置换术(TAVR)作为一种替代外科主动脉瓣置换术(SAVR)的可行方法,最近受到了关注,但关于其在移植患者中的安全性和临床结果的数据有限。我们从 2012 年至 2015 年的美国国家住院患者样本(NIS)中检索了相关的人口统计学和临床结局数据。使用 Mantzel-Hensel 检验的调整比值比(aOR)和 95%置信区间(CI)确定了 TAVR 在肾移植(RT)和肝移植(LT)患者中的临床结局。共确定了 62399 例 TAVR 患者;62180 例(99.6%)无移植史,219 例(0.4%)有 RT,85 例(0.1%)有 LT。RT 患者与无 RT 患者的住院死亡率(OR 0.61,95%CI 0.25-1.5,p=0.37)、主要心血管、呼吸或神经并发症的几率无显著差异。同样,LT 患者与无 LT 患者之间的心脏并发症、肾脏和神经并发症的几率也相同。与非移植患者相比,TAVR 似乎与有肾或肝移植史的患者发生重大全身并发症或死亡率的几率相似。

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引用本文的文献

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Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis.经导管主动脉瓣植入术后肝功能不全患者的临床转归:系统评价和荟萃分析。
BMC Cardiovasc Disord. 2022 Feb 23;22(1):67. doi: 10.1186/s12872-022-02510-2.
2
An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015-2018).使用国家住院患者样本(2015 - 2018年)对经导管主动脉瓣移植术后大出血预测因素的分析
Cureus. 2021 Jun 29;13(6):e16022. doi: 10.7759/cureus.16022. eCollection 2021 Jun.
3
Acute Kidney Injury in Transcatheter Aortic Valve Replacement.
经导管主动脉瓣置换术中的急性肾损伤
Cureus. 2021 May 21;13(5):e15154. doi: 10.7759/cureus.15154.
4
Predictors of Mortality in Patients With Transcatheter Aortic Valve Implantation: A National Inpatient Sample Database Analysis.经导管主动脉瓣植入术患者死亡率的预测因素:一项全国住院患者样本数据库分析。
Cureus. 2021 Apr 7;13(4):e14344. doi: 10.7759/cureus.14344.