Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiac Surgery, Department of Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, California.
J Surg Res. 2022 Dec;280:363-370. doi: 10.1016/j.jss.2022.07.034. Epub 2022 Aug 26.
This study aimed to characterize the use of temporary mechanical circulatory support (tMCS) among patients undergoing transcatheter aortic valve replacement (TAVR) using a nationally representative database.
The 2012-2018 National Inpatient Sample was queried for adult patients who underwent isolated TAVR. The tMCS group was comprised of those who required extracorporeal membrane oxygenation, percutaneous ventricular assist device, or intra-aortic balloon pump during index hospitalization. We evaluated temporal trends in the utilization of tMCS using Cuzick's test. Furthermore, a multivariable logistic regression was used to identify factors associated with tMCS use and its impact on in-hospital mortality, selected complications, and nonhome discharge.
Of an estimated 215,925 patients who underwent TAVR, 3085 (1.4%) required tMCS during their hospital course. The most common modality of tMCS was intra-aortic balloon pump (49%), followed by extracorporeal membrane oxygenation (27%) then percutaneous ventricular assist device (18%). Seven percent of tMCS patients were supported by > 1 device. The annual incidence of tMCS usage decreased over the study period, from 3% in 2012 to 1% in 2018 (P-trend < 0.01). Nonelective admission, congestive heart failure, coagulopathy, and liver disease were strong independent predictors of requiring tMCS. Patients requiring tMCS had a 31.8% in-hospital mortality rate (adjusted odds ratio = 23, 95% confidence interval 18.5-28.5), longer length of stay (9 d versus 3, P < 0.001), and higher costs ($84,600 versus $48,100, P < 0.001) than those who did not.
The use of tMCS during TAVR has decreased over time but remains associated with a 23-fold increased mortality rate and significant clinical and resource utilization burden.
本研究旨在利用全国代表性数据库，对行经导管主动脉瓣置换术（TAVR）患者中临时机械循环支持（tMCS）的使用情况进行描述。
本研究检索了 2012 年至 2018 年全国住院患者样本中接受单纯 TAVR 的成年患者。tMCS 组包括在指数住院期间需要体外膜肺氧合、经皮心室辅助装置或主动脉内球囊泵的患者。我们使用 Cuzick 检验评估了 tMCS 使用的时间趋势。此外，还使用多变量逻辑回归来确定与 tMCS 使用相关的因素及其对住院死亡率、选定并发症和非家庭出院的影响。
在估计接受 TAVR 的 215925 例患者中，3085 例（1.4%）在住院期间需要 tMCS。tMCS 最常见的方式是主动脉内球囊泵（49%），其次是体外膜肺氧合（27%），然后是经皮心室辅助装置（18%）。7%的 tMCS 患者使用了超过 1 种设备。研究期间，tMCS 的使用年度发生率从 2012 年的 3%下降到 2018 年的 1%（P 趋势<0.01）。非选择性入院、充血性心力衰竭、凝血障碍和肝病是需要 tMCS 的强有力独立预测因素。需要 tMCS 的患者住院死亡率为 31.8%（调整后优势比=23，95%置信区间 18.5-28.5），住院时间更长（9 天与 3 天，P<0.001），且费用更高（84600 美元与 48100 美元，P<0.001）。
随着时间的推移，TAVR 期间使用 tMCS 的情况有所减少，但与 23 倍的死亡率增加和显著的临床和资源利用负担相关。
