Wu Jing, Cong Xiaoqiang, Lou Zhiyang, Zhang Mingyou
Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, China.
Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China.
Front Cardiovasc Med. 2021 Sep 3;8:740084. doi: 10.3389/fcvm.2021.740084. eCollection 2021.
The trends of concomitant CABG and multiple-valve procedures and their impact on in-hospital outcomes in the context of transcatheter aortic valve replacement are unexplored. This was a retrospective cohort study using the administrative database of the U.S. national inpatient sample from 2012 to 2018 to identify patients who underwent SAVR with or without concomitant CABG and/or multiple-valve procedures. During the study period, a total of 75,763 representing 378,815 patients underwent SAVR nationwide were identified, of whom 42,993 (55.1%) experienced isolated SAVR, 27,133 (34.8%) underwent concomitant CABG, 5,637 (7.2%) underwent multiple-valve procedures, and 2,298 (2.9%) underwent both concomitant CABG and multiple-valve procedures. The rate of multiple-valve procedures increased from 6.1% in 2012 to 9.2% in 2018 ( < 0.001 for trend). In-hospital mortality was 2.1, 3.9, 7.3, and 11.2% for isolated SAVR, SAVR with CABG, SAVR with multiple-valve procedures, and SAVR with CABG and multiple-valve procedures, respectively. After propensity matching, compared to isolated SAVR, the risk ratio for in-hospital mortality associated with concomitant CABG was 1.54 (CI 1.39-1.70). In multiple-valve procedures, it was 2.36 (CI 1.97-2.83), and in concomitant CABG and multiple-valve procedures, it was 2.92 (CI 2.29-3.73). The proportion of patients receiving multiple-valve procedures is increasing. While concomitant CABG moderately increased in-hospital mortality, multiple-valve procedures dramatically increased in-hospital mortality and complications, even after propensity score matching.
在经导管主动脉瓣置换术背景下，冠状动脉旁路移植术（CABG）与多瓣膜手术同时进行的趋势及其对住院结局的影响尚未得到研究。这是一项回顾性队列研究，使用2012年至2018年美国国家住院样本的行政数据库，以识别接受或未接受同期CABG和/或多瓣膜手术的外科主动脉瓣置换术（SAVR）患者。在研究期间，全国共有75763例代表378815例患者接受了SAVR，其中42993例（55.1%）经历了单纯SAVR，27133例（34.8%）接受了同期CABG，5637例（7.2%）接受了多瓣膜手术，2298例（2.9%）同时接受了同期CABG和多瓣膜手术。多瓣膜手术的比例从2012年的6.1%上升至2018年的9.2%（趋势<0.001）。单纯SAVR、SAVR合并CABG、SAVR合并多瓣膜手术以及SAVR合并CABG和多瓣膜手术的住院死亡率分别为2.1%、3.9%、7.3%和11.2%。倾向评分匹配后，与单纯SAVR相比，同期CABG相关的住院死亡风险比为1.54（CI 1.39 - 1.70）。在多瓣膜手术中，风险比为2.36（CI 1.97 - 2.83），在同期CABG和多瓣膜手术中，风险比为2.92（CI 2.29 - 3.73）。接受多瓣膜手术的患者比例正在增加。虽然同期CABG适度增加了住院死亡率，但多瓣膜手术即使在倾向评分匹配后也显著增加了住院死亡率和并发症。
