Jamil Aayla K, Afzal Aasim, Nisar Tariq, Kluger Aaron Y, Felius Joost, Wencker Detlef, Hall Shelley A, Kale Parag
Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas.
Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas.
Proc (Bayl Univ Med Cent). 2021 Jan 26;34(3):345-348. doi: 10.1080/08998280.2021.1873032.
With alternatives such as gene profiling available for surveillance after orthotopic heart transplantation, we sought to evaluate the utilization of endomyocardial biopsies (EMBs) for hospitalized patients after heart transplantation. Surveillance EMBs in patients with and without complications were evaluated from the 2004 to 2014 National Inpatient Sample. Over the study period, there was no significant change in the number of EMB procedures performed ( = 0.44). Of 37,955 EMBs, 2283 (6%) were in the setting of graft complications, while 35,672 EMBs were not related to graft complications. EMBs in graft complications did not show a significant increase in length of stay over time ( = 0.06), but had a significant increase in cost over time ( = 0.001). However, those with graft complications had an average of a 5-day longer length of stay ( < 0.001) and costs that were $88,816 ( < 0.001) more expensive compared with those without graft complications. In conclusion, the vast majority of in-hospital EMBs were not related to heart transplantation complications. Nevertheless, EMB hospitalizations with graft complications showed significantly greater length of stay and cost. With the COVID-19 pandemic, it seems more effective to use minimal-contact health surveillance methods rather than invasive EMBs.
由于原位心脏移植后有基因谱分析等替代方法可用于监测，我们试图评估心脏移植后住院患者心内膜心肌活检（EMB）的使用情况。我们从2004年至2014年的全国住院患者样本中评估了有并发症和无并发症患者的监测性EMB。在研究期间，进行EMB操作的数量没有显著变化（=0.44）。在37955次EMB中，2283次（6%）是在移植物并发症的情况下进行的，而35672次EMB与移植物并发症无关。移植物并发症患者的EMB住院时间随时间没有显著增加（=0.06），但费用随时间有显著增加（=0.001）。然而，与无移植物并发症的患者相比，有移植物并发症的患者平均住院时间长5天（<0.001），费用高出88816美元（<0.001）。总之，绝大多数住院期间的EMB与心脏移植并发症无关。然而，有移植物并发症的EMB住院患者的住院时间和费用显著更高。在新冠疫情期间，使用最少接触的健康监测方法似乎比侵入性的EMB更有效。
