Thogata Harshitha, Garikipati Sushmitha, Reddy S Shanthi, Abhinav Reddy Pathe, Kumar Jella Harish
Department of General Medicine, Narayana Medical College and Hospital, Nellore, IND.
Department of General Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, IND.
Cureus. 2023 Aug 31;15(8):e44432. doi: 10.7759/cureus.44432. eCollection 2023 Aug.
Aortic valve disease is a common and impactful disorder that imposes significant health burdens and is associated with increased mortality rates. Particularly noteworthy is the emergence of transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that has revolutionized the management of aortic valve disease. However, there remain certain unresolved questions and ongoing research regarding the long-term effectiveness and suitability of TAVR in various patient populations, underscoring the need for further investigation and clinical scrutiny.
This retrospective analysis aimed to investigate the long-term outcomes and predictors of mortality in 500 patients who underwent transcatheter aortic valve replacement (TAVR).
This retrospective analysis included individuals who received transcatheter aortic valve replacement (TAVR) at Sri Venkata Sai (SVS) Medical College, Mahabubnagar, Telangana, India, between January 2020 and July 2023. Demographic characteristics, including age, gender, and comorbidities, were recorded, and long-term outcomes after TAVR were assessed, including the incidence of survival rates and major adverse cardiac events (MACE). Predictors of mortality were also identified using Cox proportional hazards regression analysis.
The study group exhibited an average age of 75.6 years (standard deviation (SD): 6.8), with 58% male and 42% female patients. Hypertension (74%), coronary artery disease (CAD) (68%), diabetes mellitus (DM) (42%), and chronic kidney disease (CKD) stage ≥ 3 (36%) were prevalent comorbidities. The median follow-up duration was 5.2 years (interquartile range (IQR): 4.3-6.8 years). The overall long-term survival rate after TAVR was 73.5% (95% confidence interval (CI): 69.8%-77.1%). Additionally, MACE occurred in 21% of patients throughout the follow-up period. The cumulative incidence of MACE at one year, three years, and five years was 6.8% (95% CI: 4.2%-9.5%), 14.2% (95% CI: 10.6%-18.7%), and 21.8% (95% CI: 17.3%-26.7%), respectively. The study found that higher age (hazard ratio (HR): 1.08, 95% CI: 1.04-1.12, p < 0.001), male gender (HR: 1.48, 95% CI: 1.15-1.91, p = 0.002), and the presence of CAD (HR: 1.72, 95% CI: 1.29-2.30, p < 0.001) were linked to an elevated risk of mortality. Additionally, diabetes mellitus (HR: 1.39, 95% CI: 1.05-1.85, p = 0.022) and CKD stage ≥ 3 (HR: 1.96, 95% CI: 1.47-2.61, p < 0.001) emerged as notable predictors of mortality. Conversely, a history of prior coronary artery bypass grafting (CABG) (HR: 0.62, 95% CI: 0.46-0.84, p = 0.003) was associated with a reduced risk of mortality. No significant associations were found between mortality and hypertension (HR: 1.12, 95% CI: 0.88-1.43, p = 0.360) or prior percutaneous coronary intervention (PCI) (HR: 1.21, 95% CI: 0.88-1.67, p = 0.245).
Age, male gender, CAD, DM, and CKD stage ≥ 3 were significant indicators of mortality risk in TAVR patients. Risk stratification and individualized management are crucial in optimizing long-term outcomes following TAVR procedures.
主动脉瓣疾病是一种常见且影响重大的疾病，会带来巨大的健康负担，并与死亡率上升相关。特别值得注意的是经导管主动脉瓣置换术（TAVR）的出现，这是一种微创手术，彻底改变了主动脉瓣疾病的治疗方式。然而，关于TAVR在不同患者群体中的长期有效性和适用性，仍存在一些未解决的问题和正在进行的研究，这突出了进一步调查和临床审查的必要性。
这项回顾性分析旨在调查500例行经导管主动脉瓣置换术（TAVR）患者的长期结局和死亡预测因素。
这项回顾性分析纳入了2020年1月至2023年7月在印度特伦甘纳邦马哈布卜纳加尔市斯里文卡塔·赛义（SVS）医学院接受经导管主动脉瓣置换术（TAVR）的患者。记录了包括年龄、性别和合并症在内的人口统计学特征，并评估了TAVR后的长期结局，包括生存率和主要不良心脏事件（MACE）的发生率。还使用Cox比例风险回归分析确定了死亡预测因素。
研究组的平均年龄为75.6岁（标准差（SD）：6.8），男性患者占58%，女性患者占42%。常见的合并症包括高血压（74%）、冠状动脉疾病（CAD）（68%）、糖尿病（DM）（42%）和慢性肾脏病（CKD）≥3期（36%）。中位随访时间为5.2年（四分位间距（IQR）：4.3 - 6.8年）。TAVR后的总体长期生存率为73.5%（95%置信区间（CI）：69.8% - 77.1%）。此外，在整个随访期间，21%的患者发生了MACE。1年、3年和5年时MACE的累积发生率分别为6.8%（95% CI：4.2% - 9.5%）、14.2%（95% CI：10.6% - 18.7%）和21.8%（95% CI：17.3% - 26.7%）。研究发现，年龄较大（风险比（HR）：1.08，95% CI：1.04 - 1.12，p < 0.001）、男性（HR：1.48，95% CI：1.15 - 1.91，p = 0.002）和存在CAD（HR：1.72，95% CI：1.29 - 2.30，p < 0.001）与死亡风险升高有关。此外，糖尿病（HR：1.39，95% CI：1.05 - 1.85，p = 0.022）和CKD≥3期（HR：1.96，95% CI：1.47 - 2.61，p < 0.001）是显著的死亡预测因素。相反，既往冠状动脉旁路移植术（CABG）史（HR：0.62，95% CI：0.46 - 0.84，p = 0.003）与死亡风险降低有关。未发现死亡率与高血压（HR：1.12，95% CI：0.88 - 1.43，p = 0.360）或既往经皮冠状动脉介入治疗（PCI）（HR：1.21，95% CI：0.88 - 1.67，p = 0.245）之间存在显著关联。
年龄、男性、CAD、DM和CKD≥3期是TAVR患者死亡风险的重要指标。风险分层和个体化管理对于优化TAVR术后的长期结局至关重要。
