Department of Cardiology, CAMC Health Education and Research Institute, Charleston, West Virginia, United States.
CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia, United States.
Am J Physiol Heart Circ Physiol. 2023 Sep 1;325(3):H539-H544. doi: 10.1152/ajpheart.00342.2023. Epub 2023 Jul 21.
We sought to assess the impact of transcatheter aortic valve replacement (TAVR) on patients that have both severe aortic stenosis (SAS) and liver cirrhosis on mortality at 365 days after index event. We identified 19,210 patients that met inclusion criteria using the TriNetX database, consisting of data from 58 large healthcare organizations collected between 1 January 2010 and 24 February 2022. Of those patients, 1,283 (3.2%) had SAS with liver cirrhosis that had a TAVR, and 19,210 (96.8%) had SAS with liver cirrhosis that did not have a TAVR. We analyzed the data to compare all-cause mortality at 365 days using the TriNetX web platform. In addition, we conducted propensity score matching (PSM) to reduce the effects of confounders between the two groups. Patients with SAS and liver cirrhosis that had a TAVR were older (72.4 ± 9.7 vs. 68.0 ± 11.8, < 0.001), and they had higher rates of heart failure (71.2 vs. 34.5%, < 0.001), coronary artery disease (72.0 vs. 31.2%, < 0.001), diabetes (52.5 vs. 41.2%, < 0.001), and chronic kidney disease (43.8 vs. 30.1%, < 0.001) compared with patients with SAS and liver cirrhosis without TAVR. PSM created two well-matched cohorts of 1,269 patients each. The TAVR group had a lower mortality rate compared with the no TAVR group (22.5 vs. 34.8%, < 0.0001) at 365 days. This was confirmed using a log-rank test. Given these data, it appears that there is a mortality benefit associated with TAVR in patients with SAS and liver cirrhosis. Risk calculators used to predict unfavorable surgical outcomes could flag a patient as ineligible for transcatheter aortic valve replacement (TAVR) based on the presence of liver cirrhosis. Our data analysis suggests that performing a TAVR to treat severe aortic stenosis in patients with liver cirrhosis could decrease their mortality risk as opposed to not performing a TAVR. Careful consideration should be given to this patient population to ensure the best quality of life and long-term outcome.
我们旨在评估经导管主动脉瓣置换术（TAVR）对同时患有严重主动脉瓣狭窄（SAS）和肝硬化的患者在指数事件后 365 天死亡率的影响。我们使用 TriNetX 数据库确定了符合纳入标准的 19210 名患者，该数据库包含了 2010 年 1 月 1 日至 2022 年 2 月 24 日来自 58 家大型医疗机构的数据。在这些患者中，有 1283 名（3.2%）患有 SAS 和肝硬化并接受了 TAVR，19210 名（96.8%）患有 SAS 和肝硬化但未接受 TAVR。我们使用 TriNetX 网络平台分析数据以比较两组患者在 365 天时的全因死亡率。此外，我们进行倾向评分匹配（PSM）以减少两组之间混杂因素的影响。与未接受 TAVR 的患者相比，接受 TAVR 的 SAS 和肝硬化患者年龄更大（72.4±9.7 岁 vs. 68.0±11.8 岁，<0.001），心力衰竭（71.2% vs. 34.5%，<0.001）、冠状动脉疾病（72.0% vs. 31.2%，<0.001）、糖尿病（52.5% vs. 41.2%，<0.001）和慢性肾病（43.8% vs. 30.1%，<0.001）的发生率更高。PSM 创建了两组各有 1269 名患者的匹配队列。与未接受 TAVR 的患者相比，TAVR 组的死亡率较低（365 天时 22.5% vs. 34.8%，<0.0001）。这一点通过对数秩检验得到了证实。根据这些数据，TAVR 似乎可以降低 SAS 和肝硬化患者的死亡率。用于预测不利手术结果的风险计算器可能会根据肝硬化的存在将患者标记为不适合接受经导管主动脉瓣置换术（TAVR）。我们的数据分析表明，在患有肝硬化的患者中，TAVR 治疗严重主动脉瓣狭窄可以降低他们的死亡率，而不是不进行 TAVR。应该对这一患者群体进行仔细考虑，以确保他们获得最佳的生活质量和长期预后。
