Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Catheter Cardiovasc Interv. 2022 Jan 1;99(1):160-168. doi: 10.1002/ccd.29847. Epub 2021 Jun 29.
This study sought to examine the association of hospital procedural volume with the incidence and outcomes of surgical bailout (SB) in patients who undergo transcatheter aortic valve replacement (TAVR).
SB is required for serious complications during or after TAVR. It remains unclear whether hospital experiences affect the incidence and outcomes of SB.
We retrospectively identified patients who underwent endovascular TAVR using the Nationwide Readmissions Database 2012-2017. We examined the association of annual hospital procedural volume (annual number of endovascular TAVR cases in each hospital in each year) with the incidence and in-hospital mortality of SB using multivariable logistic regressions and restricted cubic splines.
Among 82,764 eligible patients, the incidence of SB was 0.95% (n = 789) and decreased from 2012 to 2017 (from 2.66% to 0.49%; P < 0.001), while in-hospital mortality of SB remained high over years (from 26.0% to 23.5%; P = 0.773). Very-high-volume hospitals (≥200 cases/year), as compared with low-volume hospitals (≤49 cases/year), showed significantly a lower incidence of SB (0.49% vs. 1.81%; adjusted OR = 0.28, 95% CI = 0.21-0.38), but similar in-hospital mortality of SB (26.2% vs. 25.6%; adjusted OR = 0.88, 95% CI = 0.47-1.66). There was a significant nonlinear, inverse association of hospital volume with the incidence of SB, but not with the in-hospital mortality of SB.
Hospitals with higher TAVR volumes have a lower risk of SB, but the in-hospital mortality after SB does not change with hospital TAVR volume. Our findings highlight the importance that physicians should always be aware of the high mortality risk of SB following TAVR regardless of hospital procedural experiences.
本研究旨在探讨医院手术量与经导管主动脉瓣置换术（TAVR）患者发生外科挽救（SB）的发生率和结局的关系。
SB 是 TAVR 过程中或之后发生严重并发症时所需的措施。目前尚不清楚医院经验是否会影响 SB 的发生率和结局。
我们使用 2012 年至 2017 年全国再入院数据库，回顾性地确定了接受血管内 TAVR 的患者。我们使用多变量逻辑回归和限制立方样条分析，检查了医院每年手术量（每年每家医院进行血管内 TAVR 的病例数）与 SB 的发生率和院内死亡率的关系。
在 82764 名符合条件的患者中，SB 的发生率为 0.95%（n=789），并从 2012 年到 2017 年逐渐下降（从 2.66%降至 0.49%；P<0.001），而 SB 的院内死亡率多年来一直居高不下（从 26.0%降至 23.5%；P=0.773）。与低容量医院（≤49 例/年）相比，高容量医院（≥200 例/年）SB 的发生率明显较低（0.49%比 1.81%；调整后的 OR=0.28，95%CI=0.21-0.38），但 SB 的院内死亡率相似（26.2%比 25.6%；调整后的 OR=0.88，95%CI=0.47-1.66）。医院容量与 SB 的发生率呈显著非线性、负相关，但与 SB 的院内死亡率无相关性。
手术量较高的医院 SB 风险较低，但 SB 后的院内死亡率不会随医院 TAVR 量的变化而变化。我们的研究结果强调了医生应该始终意识到，无论医院手术经验如何，TAVR 后 SB 的死亡率都很高。
