Kawasaki Saiwai Hospital, Division of Cardiology, Kawasaki, Kanagawa, Japan.
Kawasaki Saiwai Hospital, Division of Cardiology, Kawasaki, Kanagawa, Japan.
Am J Cardiol. 2021 Jun 1;148:110-115. doi: 10.1016/j.amjcard.2021.02.031. Epub 2021 Mar 3.
Clinical outcomes of transcatheter aortic valve implantation (TAVI) have significantly improved with the accumulation of operator and institution experience as well as the wide use of newer generation devices. There is limited data on TAVI outcomes compared with surgical aortic valve replacement (SAVR) in contemporary practice in the United States. We queried the 2018 Nationwide Readmission Database of the United States. International Classification Diagnosis code 10 was used to extract TAVI and SAVR admissions. A propensity-matched cohort was created to compare TAVI and SAVR outcomes. A weighted 48,349 TAVI and 24,896 SAVR for aortic stenosis were included and 4.9% of TAVI were performed with an embolic protection device. In propensity-matched cohort (12,708 TAVI and 12,708 SAVR), TAVI conferred lower in-hospital mortality (1.7% vs 3.8%), acute kidney injury (11.3% vs 22.9%), and transfusion rate (5.9% vs. 20.6%) whereas new pacemaker rate was higher in TAVI compared with SAVR (10.5% vs. 7.0%) (all p values < 0.001). Stroke rate was similar between TAVI and SAVR (1.5% vs. 1.5%) (p value = 0.79). The routine discharge was more frequent (66.9% vs 25.8%) and length of stay was shorter (4.8 vs. 9.8 days) in TAVI than SAVR. Hospitalization cost was higher in SAVR than TAVI (51,962 vs 57,754 U.S. dollars) (all p values < 0.001). In-hospital mortality was also lower in TAVI compared with isolated SAVR. TAVI was performed more frequently than SAVR in 2018 in the United States with lower in-hospital mortality of TAVI compared with both SAVR and isolated SAVR.
经导管主动脉瓣置换术（TAVI）的临床结果随着术者和机构经验的积累以及新一代器械的广泛应用而显著改善。在美国，与同期外科主动脉瓣置换术（SAVR）相比，关于 TAVI 结果的数据有限。我们查询了美国 2018 年全国再入院数据库。国际疾病分类第 10 诊断码用于提取 TAVI 和 SAVR 入院病例。创建了倾向评分匹配队列以比较 TAVI 和 SAVR 的结果。共纳入 24896 例 SAVR 和 48349 例 TAVI 用于治疗主动脉瓣狭窄，其中 4.9%的 TAVI 采用了栓塞保护装置。在倾向评分匹配队列（12708 例 TAVI 和 12708 例 SAVR）中，TAVI 组院内死亡率（1.7% vs 3.8%）、急性肾损伤（11.3% vs 22.9%）和输血率（5.9% vs. 20.6%）较低，而 TAVI 组新起搏器植入率高于 SAVR 组（10.5% vs 7.0%）（所有 p 值均<0.001）。TAVI 和 SAVR 的卒中发生率相似（1.5% vs 1.5%）（p 值=0.79）。TAVI 的常规出院率（66.9% vs 25.8%）更高，住院时间更短（4.8 天 vs 9.8 天）。SAVR 的住院费用高于 TAVI（51962 美元 vs 57754 美元）（所有 p 值均<0.001）。与 SAVR 相比，TAVI 的院内死亡率也较低。2018 年，美国 TAVI 的实施频率高于 SAVR，TAVI 的院内死亡率低于 SAVR 和孤立的 SAVR。
