Bansal Agam, Kalra Ankur, Kumar Anirudh, Campbell Joseph, Krishnaswamy Amar, Kapadia Samir R, Reed Grant W
Cleveland Clinic, Cleveland, Ohio, USA.
Cleveland Clinic, Cleveland, Ohio, USA.
JACC Cardiovasc Interv. 2021 Dec 13;14(23):2572-2580. doi: 10.1016/j.jcin.2021.08.024. Epub 2021 Nov 10.
The aim of this study was to compare the prevalence and real-world outcomes of patients who require peripheral vascular intervention during the same hospitalization as transcatheter aortic valve replacement (TAVR) compared with TAVR alone.
There are limited data on the prevalence and outcomes of combined TAVR and percutaneous peripheral vascular intervention.
All patients who underwent TAVR in 2016 and 2017 were identified using the Nationwide Readmissions Database. Outcomes of patients undergoing TAVR alone were compared with those of patients undergoing combined TAVR and peripheral intervention, TAVR and peripheral intervention with and without a history of peripheral artery disease, and alternative-access TAVR with transfemoral TAVR in individuals undergoing peripheral intervention. The primary outcome was in-hospital mortality.
A total of 99,654 hospitalizations were identified, among which 4,397 patients (4.42%) underwent peripheral intervention during the same admission as TAVR. Patients who required peripheral intervention had increased mortality (4.2% vs 1.5%; P < 0.001), stroke (3.5% vs 1.8%; P < 0.001), acute kidney injury (17.6% vs 10.8%; P < 0.001), blood transfusion (16.0% vs 11.3%; P < 0.001), 30-day readmission (16.3% vs 12.1%; P < 0.001), median length of stay (4 days [IQR: 2-8 days] vs 3 days [IQR: 2-5 days]; P < 0.001), and hospitalization charges. Compared with patients undergoing peripheral intervention to facilitate transfemoral TAVR, alternative-access TAVR was associated with increased mortality (4.6% vs 3.0%; P = 0.036), acute kidney injury (22.7% vs 14.3%; P < 0.001), median length of stay (5 days [IQR: 3-10 days] vs 4 days [IQR: 2-7 days]; P < 0.001), and 30-day readmission (18.1% vs 15.5%; P = 0.012).
Peripheral vascular intervention may be used to facilitate transfemoral access or as a bailout for vascular complications during TAVR. Combined TAVR and peripheral intervention is associated with an increased risk for adverse events, though outcomes are better compared with alternative-access TAVR using a nonfemoral approach.
本研究旨在比较在与经导管主动脉瓣置换术（TAVR）同期住院期间需要进行外周血管介入治疗的患者与单纯接受TAVR治疗的患者的患病率及实际治疗结果。
关于TAVR与经皮外周血管介入联合治疗的患病率及治疗结果的数据有限。
利用全国再入院数据库识别出2016年和2017年所有接受TAVR治疗的患者。将单纯接受TAVR治疗的患者的治疗结果与接受TAVR联合外周介入治疗的患者、有或无外周动脉疾病史的接受TAVR联合外周介入治疗的患者，以及在接受外周介入治疗的患者中采用经心尖TAVR与经股动脉TAVR的治疗结果进行比较。主要结局为住院死亡率。
共识别出99654次住院治疗，其中4397例患者（4.42%）在与TAVR同期住院期间接受了外周介入治疗。需要进行外周介入治疗的患者死亡率更高（4.2%对1.5%；P<0.001）、卒中发生率更高（3.5%对1.8%；P<0.001）、急性肾损伤发生率更高（17.6%对10.8%；P<0.001）、输血率更高（16.0%对11.3%；P<0.001）、30天再入院率更高（16.3%对12.1%；P<0.001）、中位住院时间更长（4天[四分位间距：2 - 8天]对3天[四分位间距：2 - 5天]；P<0.001），且住院费用更高。与为便于经股动脉TAVR而进行外周介入治疗的患者相比，经心尖TAVR与更高的死亡率（4.6%对3.0%；P = 0.036）、急性肾损伤发生率（22.7%对14.3%；P<0.001）、中位住院时间（5天[四分位间距：3 - 10天]对4天[四分位间距：2 - 7天]；P<0.001）及30天再入院率（18.1%对15.5%；P = 0.012）相关。
外周血管介入治疗可用于便于经股动脉入路或作为TAVR期间血管并发症的补救措施。TAVR与外周介入联合治疗与不良事件风险增加相关，不过与采用非股动脉入路的经心尖TAVR相比，治疗结果更好。
