Ugwu Justin K, Ndulue Jideofor K, Sherif Khaled A, Alliu Samson, Elbadawi Ayman, Taskesen Tuncay, Hussein Doha, Ugwu Erugo Judith N, Chatila Khaled F, Almustafa Ahmed, Khalife Wissam I, Kumfa Paul N
Cardiovascular Disease Fellowship, MercyOne Des Moines Medical Center/Iowa Heart Center, 1111 6th Ave, Des Moines, IA, 50314, USA.
Providence Medical Group, Chehalis Family Medicine, 931 S Market Blvd, Chehalis, WA, 98532, USA.
Cardiol Ther. 2022 Mar;11(1):143-154. doi: 10.1007/s40119-022-00258-6. Epub 2022 Mar 6.
There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA.
We queried the National Inpatient Sample database (2012-2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that > 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA.
From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28-1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0-7.0) versus 3 days (IQR 2.0-6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73-1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81-1.69), p = 0.40], aortic dissection [OR 2.38 (0.41-13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18-1.16), p = 0.09], vascular complications [OR 0.80 (0.34-1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81-1.57), p = 0.42], blood transfusion [OR 1.20 (0.84-1.70), p = 0.26], and stroke [OR 0.58 (0.24-1.39), p = 0.25] were similar in those with and without AA.
Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA.
关于经导管主动脉瓣置换术（TAVR）在胸主动脉瘤或腹主动脉瘤（AA）患者中的预后数据较少。利用全国住院患者样本（NIS）数据库，我们探讨了TAVR在诊断为AA的患者中的安全性。
我们查询了国家住院患者样本数据库（2012 - 2017年）中接受TAVR的住院患者，使用ICD - 9和ICD - 10编码来确定血管内TAVR。报告显示，美国超过95%的血管内TAVR是通过经股动脉途径进行的，所以我们的研究人群主要是接受经股动脉TAVR的患者。采用倾向评分匹配法，我们比较了有和没有AA的患者中TAVR手术的趋势和预后。
在2012年1月至2017年12月期间接受TAVR手术的29517名个体的总样本中，910人被诊断为AA。在774对匹配对分析中，有和没有AA的患者全因住院死亡率相似，比值比为0.63[（95%置信区间0.28 - 1.43），p = 0.20]。AA患者的中位住院时间更长：4天（四分位间距2.0 - 7.0），而无AA患者为3天（四分位间距2.0 - 6.0），p = 0.01。急性肾损伤风险[比值比1.01（0.73 - 1.39），p = 0.87]、需要植入起搏器的心脏传导阻滞[比值比1.17（0.81 - 1.69），p = 0.40]、主动脉夹层[比值比2.38（0.41 - 13.75），p = 0.25]、急性肢体缺血[比值比0.46（0.18 - 1.16），p = 0.09]、血管并发症[比值比0.80（0.34 - 1.89），p = 0.53]、术后出血[比值比1.12（0.81 - 1.57），p = 0.42]、输血[比值比1.20（0.84 - 1.70），p = 0.26]和中风[比值比0.58（0.24 - 1.39），p = 0.25]在有和没有AA的患者中相似。
来自一个大型全国性数据库的数据表明，与没有AA的患者相比，接受TAVR的AA患者的住院结局相似。
