Murthi Mukunthan, Velagapudi Sujitha, Sharma Bharosa, Ezegwu Olisa, Akuna Emmanuel, Park Dae Yong, Atluri Ramtej, Vardar Ufuk
Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA.
Cureus. 2022 Apr 27;14(4):e24534. doi: 10.7759/cureus.24534. eCollection 2022 Apr.
Background The transcatheter aortic valve replacement (TAVR) procedure has been increasingly utilized in the management of aortic stenosis among the elderly. In this study, we sought to assess the hospital outcomes and major adverse events (MAEs) associated with TAVR in patients aged ≥80 years compared to those aged <80 years. Methodology We performed a retrospective observational study using the National Inpatient Sample in 2018. We divided TAVR patients into two cohorts based on age, namely, ≥80 years old and <80 years old. The primary outcomes included the comparison of in-hospital mortality and MAEs in the two cohorts. Results We identified 63,630 patients who underwent TAVR from January 1 to December 31, 2018. Among them, 35,115 (55%) were ≥80 years and 28,515 (45%) were <80 years of age. There was a higher rate of post-procedural in-hospital mortality in patients ≥80 years old (1.6% vs. 1.1%, adjusted odds ratio (aOR) = 1.56, [confidence interval (CI) = 1.13-2.16], p = 0.006). They also had higher rates of pacemaker insertion compared to those <80 years old (7.4% vs. 6.5%, aOR = 1.17 [CI = 1-1.35], p = 0.03). On subgroup analysis, the rates of MAEs were not different between the two cohorts (23.8% vs. 23.4%, p = 0.09); however, patients aged ≥80 years who experienced MAEs had higher in-hospital mortality (5.7% vs. 4.3%, aOR = 1.58 [CI = 1.08-2.32], p = 0.01) and shorter length of hospital stay (7.2 vs. 8.7 days, p = 0.03) compared to those aged <80 years. Anemia, liver disease, chronic kidney disease, and previous stroke were associated with higher odds of in-hospital MAEs in both groups. Conclusions The results of our study show that patients older than 80 years of age undergoing TAVR had higher rates of in-hospital mortality and pacemaker insertion compared to those less than 80 years of age. The rates of MAEs were not significantly different between the two groups.
背景 经导管主动脉瓣置换术（TAVR）已越来越多地用于老年主动脉瓣狭窄的治疗。在本研究中，我们旨在评估≥80岁患者与<80岁患者TAVR术后的院内结局和主要不良事件（MAE）。方法 我们使用2018年全国住院患者样本进行了一项回顾性观察研究。我们根据年龄将TAVR患者分为两个队列，即≥80岁和<80岁。主要结局包括两个队列的院内死亡率和MAE的比较。结果 我们确定了2018年1月1日至12月31日期间接受TAVR的63630例患者。其中，35115例（55%）≥80岁，28515例（45%）<80岁。≥80岁患者术后院内死亡率较高（1.6%对1.1%，调整优势比（aOR）=1.56，[置信区间（CI）=1.13-2.16]，p=0.006）。与<80岁患者相比，他们起搏器植入率也更高（7.4%对6.5%，aOR=1.17 [CI=1-1.35]，p=0.03）。亚组分析显示，两个队列的MAE发生率无差异（23.8%对23.4%，p=0.09）；然而，发生MAE的≥80岁患者与<80岁患者相比，院内死亡率更高（5.7%对4.3%，aOR=1.58 [CI=1.08-2.32]，p=0.01），住院时间更短（7.2天对8.7天，p=0.03）。贫血、肝病、慢性肾病和既往中风与两组患者院内MAE的较高发生率相关。结论 我们的研究结果表明，与<80岁患者相比，≥80岁接受TAVR的患者院内死亡率和起搏器植入率更高。两组之间MAE的发生率无显著差异。
