XXX, Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
XXX, Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Am J Cardiol. 2022 Jul 15;175:72-79. doi: 10.1016/j.amjcard.2022.03.052. Epub 2022 May 11.
Recently, transcatheter aortic valve implantation (TAVI) has been performed in patients with combined aortic stenosis (AS) and aortic regurgitation. We sought to evaluate in-hospital outcomes and readmission rates after TAVI in patients with mixed aortic valve disease (MAVD). A total of 100,573 TAVI procedures were identified between 2011 and 2017 using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision procedure codes the from Nationwide Readmissions Database. We separated patients into 2 cohorts, those with MAVD and those with pure AS. The primary outcome was all-cause inpatient mortality after TAVI, and secondary outcomes included rates of 30- and 90-day readmissions and postprocedural complications. A total of 3,260 patients had MAVD (median age 83 years, 43.5% women). In-hospital mortality (2.5% vs 2.6%, p = 0.531) and rates of paravalvular leak (1.0% vs 1.3%, p = 0.056) were similar between the MAVD and pure AS groups. Major bleeding (7.4% vs 9.6%, p <0.001), 30-day readmission (0.5% vs 8.8%, p <0.001) and 90-day readmission rates (0.8% vs 16.0%, p <0.001), acute kidney injury (12.9% vs 15.1%, p <0.001), postoperative ischemic stroke (2.0% vs 5.7%, p <0.001), and mechanic circulatory support use (1.9% vs 4.5%, p <0.001) were less prevalent in the MAVD cohort. Using a multivariate logistic regression model to adjust for confounding factors, MAVD was not predictive of mortality in patients who underwent TAVI (adjusted odds ratio [adjOR] 1.25, 95% confidence interval [CI] 0.99 to 1.57, p = 0.056); however, MAVD was associated with: decreased odds of 30-day readmission (adjOR 0.05, 95% CI 0.03 to 0.08, p <0.001), 90-day readmission rates (adjOR 0.04, 95% CI 0.03 to 0.06, p <0.001), and higher odds of pacemaker implantation (adjOR 1.46, 95% CI 1.29 to 1.65, p <0.001). In conclusion, despite differences in the aortic valve and left ventricular anatomy (pressure vs volume-related adaptive changes) in patients with MAVD and pure AS, TAVI appears safe and feasible. However, patients with MAVD were more likely to have permanent pacemakers implanted. The results of our study warrant further randomized controlled studies to confirm these findings.
最近，经导管主动脉瓣植入术（TAVI）已应用于合并主动脉瓣狭窄（AS）和主动脉瓣反流的患者。我们旨在评估在混合主动脉瓣疾病（MAVD）患者中 TAVI 的住院内结局和再入院率。使用来自全国再入院数据库的国际疾病分类，第九版和国际疾病分类，第十版程序代码，我们在 2011 年至 2017 年期间确定了 100,573 例 TAVI 手术。我们将患者分为 2 组，一组为 MAVD，一组为单纯 AS。主要结局是 TAVI 后的全因住院内死亡率，次要结局包括 30 天和 90 天再入院率和术后并发症。共有 3260 例患者患有 MAVD（中位年龄 83 岁，43.5％为女性）。住院内死亡率（2.5％与 2.6％，p = 0.531）和瓣周漏的发生率（1.0％与 1.3％，p = 0.056）在 MAVD 和单纯 AS 组之间相似。主要出血（7.4％与 9.6％，p <0.001），30 天再入院率（0.5％与 8.8％，p <0.001）和 90 天再入院率（0.8％与 16.0％，p <0.001），急性肾损伤（12.9％与 15.1％，p <0.001），术后缺血性中风（2.0％与 5.7％，p <0.001）和机械循环支持的使用（1.9％与 4.5％，p <0.001）在 MAVD 组中较少见。使用多变量逻辑回归模型调整混杂因素后，MAVD 对接受 TAVI 的患者的死亡率无预测作用（调整后的优势比[adjOR] 1.25，95％置信区间[CI] 0.99 至 1.57，p = 0.056）；然而，MAVD 与：30 天再入院率（adjOR 0.05，95％CI 0.03 至 0.08，p <0.001），90 天再入院率（adjOR 0.04，95％CI 0.03 至 0.06，p <0.001），和更高的永久性起搏器植入率（adjOR 1.46，95％CI 1.29 至 1.65，p <0.001）相关。总之，尽管 MAVD 和单纯 AS 患者的主动脉瓣和左心室解剖结构（压力与容量相关的适应性改变）存在差异，但 TAVI 似乎是安全可行的。然而，患有 MAVD 的患者更有可能植入永久性起搏器。我们研究的结果需要进一步的随机对照研究来证实这些发现。
