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基于人群的研究:三尖瓣反流患者行经导管三尖瓣修复术与外科三尖瓣修复术的趋势和结局。

Trends and Outcomes of Transcatheter Tricuspid Valve Repair and Surgical Tricuspid Valve Repair in Patients With Tricuspid Valve Regurgitation; A Population Based Study.

机构信息

Department of Internal Medicine, Rochester General Hospital, Rochester, NY.

Department of Internal Medicine, Rochester General Hospital, Rochester, NY.

出版信息

Curr Probl Cardiol. 2023 Jul;48(7):101714. doi: 10.1016/j.cpcardiol.2023.101714. Epub 2023 Mar 24.

DOI:10.1016/j.cpcardiol.2023.101714
PMID:36967066
Abstract

Data on clinical outcomes of transcatheter tricuspid valve repair (TTVR) compared with surgical tricuspid valve repair (STVR) in patients with tricuspid valve regurgitation (TVR) remains limited. Data from the national inpatient sample (2016-2020) and propensity-score matched (PSM) analysis was utilized to determine adjusted odds ratio (aOR) of inpatient mortality and major clinical outcomes of TTVR compated with STVR in patients with TVR. A total of 37,115 patients with TVR were included: 1830 (4.9%) and 35,285 (95.1%) underwent TTVR and STVR, respectively. After PSM, there was no statistically significant difference in baseline characteristics and medical comorbidities between both groups. Compared with STVR, TTVR was associated with lower inpatient mortality (aOR 0.43 [0.31-0.59], P < 0.01), cardiovascular complications (aOR 0.47 [0.3-0.45], P < 0.01), hemodynamic complications (aOR 0.47 [0.4-0.55], P < 0.01), infectious complications (aOR 0.44 [0.34-0.57], P < 0.01), renal complications (aOR 0.56 [0.45-0.64], P < 0.01), and need for blood transfusion. There was no statistically significant difference in odds of major bleeding events (aOR 0.92 [0.64-1.45], P 0.84). Also, TTVR was associated with less mean length of stay (7 days vs 15 days, P < 0.01) and less cost of hospitalization ($59,921 vs $89,618) compared with STVR. There was an increase in the utility of TTVR associated with a decrease in the utility of STVR from 2016 to 2020 (P < 0.01). Our study showed that compared with STVR, TTVR was associated with lower inpatient mortality and clinical events. Nevertheless, further studies are needed to investigate the difference in outcomes between both procedures.

摘要

关于经导管三尖瓣修复术(TTVR)与三尖瓣反流(TR)患者的外科三尖瓣修复术(STVR)的临床结果数据仍然有限。利用全国住院患者样本(2016-2020 年)和倾向评分匹配(PSM)分析来确定 TR 患者 TTVR 与 STVR 的住院死亡率和主要临床结果的调整优势比(aOR)。共纳入 37115 例 TR 患者:1830 例(4.9%)和 35285 例(95.1%)分别接受了 TTVR 和 STVR。PSM 后,两组间基线特征和合并症无统计学差异。与 STVR 相比,TTVR 与较低的住院死亡率(aOR 0.43 [0.31-0.59],P < 0.01)、心血管并发症(aOR 0.47 [0.30-0.45],P < 0.01)、血液动力学并发症(aOR 0.47 [0.40-0.55],P < 0.01)、感染性并发症(aOR 0.44 [0.34-0.57],P < 0.01)、肾脏并发症(aOR 0.56 [0.45-0.64],P < 0.01)和输血需求有关。大出血事件的几率无统计学差异(aOR 0.92 [0.64-1.45],P 0.84)。此外,与 STVR 相比,TTVR 的平均住院时间较短(7 天 vs 15 天,P < 0.01),住院费用较低(59921 美元 vs 89618 美元)。从 2016 年到 2020 年,TTVR 的应用增加,而 STVR 的应用减少(P < 0.01)。我们的研究表明,与 STVR 相比,TTVR 与较低的住院死亡率和临床事件相关。然而,需要进一步的研究来探讨这两种手术方法的结果差异。

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