Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
Cardiovasc Revasc Med. 2022 Jun;39:20-25. doi: 10.1016/j.carrev.2021.10.011. Epub 2021 Oct 28.
The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR.
The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality.
Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04].
In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.
经导管主动脉瓣置换术（TAVR）后舒张压（DBP）和脉压（PP）与结局之间的关系尚不清楚。我们旨在评估成人 TAVR 术后 DBP 和 PP 升高与术后主动脉瓣关闭不全（AI）和死亡率的发生率、预测因素和影响。
该研究人群包括 2016 年至 2017 年在一所学术性三级医疗中心接受 TAVR 的 194 名患者，其中 176 名患者术后可获得有创动脉压力。低 DBP 和宽 PP 定义为术后第 1 天有创动脉线上分别为≤40mmHg 和≥80mmHg。感兴趣的临床结局包括术后 AI 和 1 年全因死亡率。
研究人群中，术后低 DBP 和宽 PP 的发生率分别为 32.4%和 58.5%。术后 AI 与低 DBP 之间无显著相关性（p=0.82）或宽 PP（p=0.32）。低 DBP 组的死亡率较高（19.3% vs 9.2%，p=0.06），但宽 PP 组（10.7% vs 15.1%，p=0.39）或≥1+ 术后 AI 组（16.7% vs 10.7%，p=0.32）的死亡率无差异。多变量分析显示，低 DBP 与 1 年死亡率升高呈趋势相关[比值比（OR）2.43，95%置信区间（CI）0.97-6.11，p=0.06]。当排除术后有创收缩压<80mmHg 的患者时，低 DBP 与 1 年时风险调整死亡率显著升高相关[OR 2.75，95%CI（1.07-7.07），p=0.04]。
在这项对接受 TAVR 的成人进行的现代研究中，TAVR 后低 DBP 和宽 PP 广泛存在。低 DBP 与 1 年死亡率升高呈趋势相关，但与术后 AI 无关。
