Shah Kashyap, Krinock Matthew, Thyagaturu Harshith, Munshi Rezwan, Pandya Ayushi, Falta Sarah, Hippen John, Durkin Michael
Internal Medicine, St. Luke's University Health Network, Bethlehem, USA.
Internal Medicine, Bassett Healthcare Network, Bassett, USA.
Cureus. 2021 Jul 1;13(7):e16083. doi: 10.7759/cureus.16083. eCollection 2021 Jul.
Background Pericardial disease (PD) - acute pericarditis (AP) and pericardial effusion (PE) - is a rare complication of transcatheter aortic valve repair (TAVR) although its prevalence, predictors, and outcomes are not well studied. Methods We used the National Inpatient Sample (NIS) database to find patients who received TAVR between 2011 and 2018. TAVR patients were divided into two groups: with and without PD (AP and/or PE). The baseline characteristics between the two groups were compared using the Chi-square test and student t-test. Variables with a p-value of 0.20 or less from the univariate logistic regression were included in the multivariate logistic regression to find independent predictors of PD in TAVR patients. Results Out of 218,340 TAVR hospitalizations, 4323 (1.2%) had a concurrent diagnosis of PD. TAVR patients with PD were older (81 ± 7 vs 80 ± 6 years, p < 0.05), more likely to be females (62 vs 46%, p < 0.001), white (84.2 vs 82.9%, p = 0.83), and had a higher burden of comorbidities (Table 3). TAVR patients with PD had higher in-hospital mortality rate (12.3 vs 1.9%, p < 0.001), mean length of stay (8.4 vs 5.3 days, p < 0.001), and mean total hospital cost ($283,389 vs $224,544, p < 0.001). Age > 75, female sex, atrial fibrillation (Afib), atrial flutter (Aflutter), peripheral vascular disease (PVD), coagulopathy, cirrhosis, malnutrition, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and pacemaker (PM) implantation were the independent predictors of PD in TAVR patients. Conclusion Older, white females with a higher burden of comorbidities and cardiovascular procedures are at higher risk of pericardial complications of TAVR procedure. Sex-based disparities in the prevalence of PD after TAVR is an area of further research. Careful selection of patients for TAVR is essential to reduce the burden of these complications.
心包疾病（PD）——急性心包炎（AP）和心包积液（PE）——是经导管主动脉瓣修复术（TAVR）的一种罕见并发症，尽管其患病率、预测因素和结局尚未得到充分研究。方法：我们使用国家住院样本（NIS）数据库查找2011年至2018年间接受TAVR的患者。TAVR患者分为两组：有PD（AP和/或PE）组和无PD组。使用卡方检验和学生t检验比较两组之间的基线特征。单因素逻辑回归中p值小于或等于0.20的变量纳入多因素逻辑回归，以确定TAVR患者中PD的独立预测因素。结果：在218,340例TAVR住院病例中，4323例（1.2%）同时诊断为PD。患有PD的TAVR患者年龄更大（81±7岁 vs 80±6岁，p<0.05），女性比例更高（62% vs 46%，p<0.001），白人比例更高（84.2% vs 82.9%，p = 0.83），且合并症负担更重（表3）。患有PD的TAVR患者住院死亡率更高（12.3% vs 1.9%，p<0.001），平均住院时间更长（8.4天 vs 5.3天，p<0.001），平均总住院费用更高（283,389美元 vs 224,544美元，p<0.001）。年龄>75岁、女性、心房颤动（Afib）、心房扑动（Aflutter）、外周血管疾病（PVD）、凝血障碍、肝硬化、营养不良、经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）和起搏器（PM）植入是TAVR患者中PD的独立预测因素。结论：年龄较大、合并症负担较重且接受心血管手术的白人女性发生TAVR心包并发症的风险更高。TAVR术后PD患病率的性别差异是一个有待进一步研究的领域。仔细选择TAVR患者对于减轻这些并发症的负担至关重要。
