Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas.
Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas.
Tex Heart Inst J. 2023 May 1;50(3). doi: 10.14503/THIJ-21-7775.
This study assessed in-hospital outcomes of patients with chronic systolic, diastolic, or mixed heart failure (HF) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).
The Nationwide Inpatient Sample database was used to identify patients with aortic stenosis and chronic HF who underwent TAVR or SAVR between 2012 and 2015. Propensity score matching and multivariate logistic regression were used to determine outcome risk.
A cohort of 9,879 patients with systolic (27.2%), diastolic (52.2%), and mixed (20.6%) chronic HF were included. No statistically significant differences in hospital mortality were noted. Overall, patients with diastolic HF had the shortest hospital stays and lowest costs. Compared with patients with diastolic HF, the risk of acute myocardial infarction (TAVR odds ratio [OR], 1.95; 95% CI, 1.20-3.19; P = .008; SAVR OR, 1.38; 95% CI, 0.98-1.95; P = .067) and cardiogenic shock (TAVR OR, 2.15; 95% CI, 1.43-3.23; P < .001; SAVR OR, 1.89; 95% CI, 1.42-2.53; P ≤ .001) was higher in patients with systolic HF, whereas the risk of permanent pacemaker implantation (TAVR OR, 0.58; 95% CI, 0.45-0.76; P < .001; SAVR OR, 0.58; 95% CI, 0.40-0.84; P = .004) was lower following aortic valve procedures. In TAVR, the risk of acute deep vein thrombosis and kidney injury was higher, although not statistically significant, in patients with systolic HF than in those with diastolic HF.
These outcomes suggest that chronic HF types do not incur statistically significant hospital mortality risk in patients undergoing TAVR or SAVR.
本研究评估了慢性收缩性、舒张性或混合性心力衰竭（HF）患者行经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）的住院期间结局。
利用全国住院患者样本数据库，确定了 2012 年至 2015 年间接受 TAVR 或 SAVR 的主动脉瓣狭窄合并慢性 HF 患者。采用倾向评分匹配和多变量逻辑回归来确定结局风险。
纳入了 9879 例收缩性（27.2%）、舒张性（52.2%）和混合性（20.6%）慢性 HF 患者。两组患者的院内死亡率无统计学差异。总体而言，舒张性 HF 患者的住院时间最短，费用最低。与舒张性 HF 患者相比，收缩性 HF 患者发生急性心肌梗死的风险更高（TAVR 比值比 [OR]，1.95；95%置信区间 [CI]，1.20-3.19；P =.008；SAVR OR，1.38；95% CI，0.98-1.95；P =.067）和心源性休克（TAVR OR，2.15；95% CI，1.43-3.23；P <.001；SAVR OR，1.89；95% CI，1.42-2.53；P ≤.001），而永久性心脏起搏器植入的风险更低（TAVR OR，0.58；95% CI，0.45-0.76；P <.001；SAVR OR，0.58；95% CI，0.40-0.84；P =.004）。在 TAVR 中，尽管没有统计学意义，但收缩性 HF 患者的急性深静脉血栓形成和肾损伤风险高于舒张性 HF 患者。
这些结局表明，慢性 HF 类型不会导致接受 TAVR 或 SAVR 的患者发生有统计学意义的院内死亡率风险。
