Slade Justin J, Ambrosy Andrew P, Leong Thomas K, Sung Sue Hee, Garcia Elisha A, Ku Ivy A, Solomon Matthew D, McNulty Edward J, Rassi Andrew N, Lange David C, Philip Femi, Go Alan S, Mishell Jacob M
Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Struct Heart. 2023 Mar 21;7(4):100166. doi: 10.1016/j.shj.2023.100166. eCollection 2023 Jul.
Transcatheter aortic valve replacement (TAVR) may be used to urgently or emergently treat severe aortic stenosis, but outcomes for this high-risk population have not been well-characterized. We sought to describe the incidence, clinical characteristics, and outcomes of patients undergoing urgent or emergent vs. elective TAVR.
We identified all adults who received TAVR for primary aortic stenosis between 2013 and 2019 within an integrated health care delivery system in Northern California. Elective or urgent/emergent procedure status was based on standard Society of Thoracic Surgeons definitions. Data were obtained from electronic health records, the Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy Registry, and state/national reporting databases. Logistic regression and Cox proportional hazard models were performed.
Among 1564 eligible adults that underwent TAVR, 81 (5.2%) were classified as urgent/emergent. These patients were more likely to have heart failure (63.0% vs. 47.4%), reduced left ventricular ejection fraction (21.0% vs. 11.8%), or a prior aortic valve balloon valvuloplasty (13.6% vs. 5.0%) and experienced higher unadjusted rates of 30-day and 1-year morbidity and mortality. Urgent/emergent TAVR status was independently associated with non-improved quality of life at 30-days (hazard ratio, 4.87; < 0.01) and acute kidney injury within 1-year post-TAVR (hazard ratio, 2.11; = 0.01). There was not a significant difference in adjusted 1-year mortality with urgent/emergent TAVR.
Urgent/emergent TAVR status was uncommon and associated with high-risk clinical features and higher unadjusted rates of short- and long-term morbidity and mortality. Procedure status may be useful to identify patients less likely to experience significant short term improvement in health-related quality of life post-TAVR.
经导管主动脉瓣置换术（TAVR）可用于紧急或急诊治疗严重主动脉瓣狭窄，但这一高危人群的治疗效果尚未得到充分描述。我们试图描述接受紧急或急诊TAVR与择期TAVR患者的发生率、临床特征及治疗效果。
我们确定了2013年至2019年期间在北加利福尼亚州一个综合医疗保健系统内因原发性主动脉瓣狭窄接受TAVR的所有成年人。择期或紧急/急诊手术状态基于胸外科医师协会的标准定义。数据来自电子健康记录、胸外科医师协会-美国心脏病学会经导管瓣膜治疗注册中心以及州/国家报告数据库。进行了逻辑回归和Cox比例风险模型分析。
在1564例接受TAVR的符合条件的成年人中，81例（5.2%）被归类为紧急/急诊。这些患者更有可能患有心力衰竭（63.0%对47.4%）、左心室射血分数降低（21.0%对11.8%）或既往有主动脉瓣球囊瓣膜成形术（13.6%对5.0%），并且30天和1年的发病率和死亡率未经调整的发生率更高。紧急/急诊TAVR状态与30天时生活质量未改善（风险比，4.87；<0.01）以及TAVR后1年内急性肾损伤（风险比，2.11；=0.01）独立相关。紧急/急诊TAVR调整后的1年死亡率没有显著差异。
紧急/急诊TAVR状态并不常见，且与高危临床特征以及短期和长期发病率和死亡率的较高未调整发生率相关。手术状态可能有助于识别TAVR后健康相关生活质量不太可能在短期内显著改善的患者。
