Gad Mohamed M, Lichtman Devora, Saad Anas M, Isogai Toshiaki, Bansal Agam, Abdallah Mouin S, Roselli Eric, Chatterjee Soumya, Reed Grant W, Kapadia Samir R, Menon Venu, Wassif Heba
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
Department of Cardiology, Medstar Heart and Vascular Institute, Fairfax, VA 22031, USA.
Eur Heart J Open. 2022 Apr 6;2(3):oeac024. doi: 10.1093/ehjopen/oeac024. eCollection 2022 May.
Patients with autoimmune connective tissue diseases (CTDs) have a high burden of valvular heart disease and are often thought of as high surgical risk patients.
Patients undergoing aortic valve replacement (AVR) were identified in the Nationwide Readmissions Database between January 2012 and December 2018. Patients with a history of systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed C, Sjögren syndrome, polymyositis, and dermatomyositis were included in the CTD cohort. Patients undergoing coronary artery bypass grafting concomitantly with AVR were excluded. A total of 569 600 hospitalizations were included, of which16 531 (2.9%) had CTD. CTD patients were more likely to be females, with higher rates of heart failure, pulmonary hypertension, and more likely to be insured by Medicare. CTD patients had lower mortality than non-CTD patients [odds ratio (OR) 0.66; 95% confidence interval (CI): 0.59-0.74] and stroke [OR 0.87; 95% (CI): 0.79-0.97]. CTD patients undergoing SAVR had lower mortality [OR 0.69; 95% (CI): 0.60-0.80] and stroke [OR 0.86; 95% (CI): 0.75-0.98). CTD patients undergoing TAVR had lower mortality outcomes [OR 0.67; 95% (CI): 0.56-0.80]; however, they had comparable stroke outcomes [OR 0.97; 95% (CI): 0.83-1.13, = 0.69].
Outcomes for patients with CTD requiring AVR are not inferior to their non-CTD counterparts. A comprehensive heart team selection of patients undergoing AVR approaches should place CTD history under consideration; however, pre-existing CTD should not be prohibitive of AVR interventions.
自身免疫性结缔组织病（CTD）患者瓣膜性心脏病负担较重，常被视为手术高风险患者。
在2012年1月至2018年12月的全国再入院数据库中识别接受主动脉瓣置换术（AVR）的患者。有系统性红斑狼疮、类风湿关节炎、系统性硬化症、混合性结缔组织病、干燥综合征、多发性肌炎和皮肌炎病史的患者纳入CTD队列。同时接受冠状动脉旁路移植术和AVR的患者被排除。共纳入569600例住院患者，其中16531例（2.9%）患有CTD。CTD患者更可能为女性，心力衰竭、肺动脉高压发生率更高，且更可能由医疗保险承保。CTD患者的死亡率低于非CTD患者[比值比（OR）0.66；95%置信区间（CI）：0.59 - 0.74]，中风发生率也较低[OR 0.87；95%（CI）：0.79 - 0.97]。接受外科主动脉瓣置换术（SAVR）的CTD患者死亡率较低[OR 0.69；95%（CI）：0.60 - 0.80]，中风发生率也较低[OR 0.86；95%（CI）：0.75 - 0.98]。接受经导管主动脉瓣置换术（TAVR）的CTD患者死亡率较低[OR 0.67；95%（CI）：0.56 - 0.80]；然而，他们的中风发生率相当[OR 0.97；95%（CI）：0.83 - 1.13，P = 0.69]。
需要AVR的CTD患者的手术结果并不逊于非CTD患者。心脏综合团队在选择接受AVR的患者时应考虑CTD病史；然而，已有的CTD不应成为AVR干预的障碍。
