Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
Institute of Anaesthesiology, German Heart Center Munich, Technical University of Munich, Germany.
Cardiovasc Revasc Med. 2024 May;62:27-33. doi: 10.1016/j.carrev.2023.11.019. Epub 2023 Nov 30.
Data on systemic inflammatory response syndrome (SIRS) after transcatheter aortic valve implantation (TAVI) are scarce and limited to small cohorts. We aimed to investigate its incidence and mid-term impact in a large cohort of TAVI patients.
From January 2018 to December 2020, 717 patients with severe aortic valve stenosis undergoing TAVI were included. SIRS was defined as fulfilling at least two of the following criteria within 48 h from the procedure: leucocyte count >12.0 or <4.0 × 10/l, respiratory rate > 20 breaths per minute or PaCO ≤ 4.3 kPa/32 mmHg, heart rate > 90 beats per minute and temperature > 38.0 °C or <36.0 °C. Clinical endpoints were 1-year rehospitalization for chronic heart failure (CHF) and 2-years all-cause mortality. Event rates during follow-up were calculated as Kaplan-Meier estimates.
SIRS developed in 56.3 % (404/717) of patients after TAVI. SIRS occurred more frequently in patients with post-dilatation (SIRS 34.7 % (140/404) vs. no SIRS 23.3 % (73/313); p < 0.001) and major vascular complications (SIRS 16.1 % (65/404) vs. no SIRS 8.6 % (27/313); p = 0.004). Further, ICU days were more in patients who developed SIRS (SIRS 1.56 ± 1.50 days vs. no SIRS 1.22 ± 1.02 days; p = 0.001). At 2-years, all-cause mortality in the entire population was 23.9 %. However, there was no difference in CHF at 1-year (5.9 % vs. 4.1 %; log-rank = 0.347) nor in all-cause mortality at 2-years (22.0 % vs. 26.2 %; log-rank = 0.690) between the groups.
SIRS is a common finding after TAVI, which may prolong hospital stay but is without effect on mortality during 2-years follow-up.
经导管主动脉瓣植入术（TAVI）后全身炎症反应综合征（SIRS）的数据很少且仅限于小队列。我们旨在研究其在大量 TAVI 患者中的发生率和中期影响。
从 2018 年 1 月至 2020 年 12 月，纳入 717 例患有严重主动脉瓣狭窄的患者进行 TAVI。SIRS 定义为在手术后 48 小时内满足以下至少两项标准：白细胞计数>12.0 或<4.0×10/l，呼吸频率>20 次/分钟或 PaCO≤4.3kPa/32mmHg，心率>90 次/分钟和体温>38.0°C 或<36.0°C。临床终点是 1 年因慢性心力衰竭（CHF）再住院和 2 年全因死亡率。随访期间的事件发生率按 Kaplan-Meier 估计。
TAVI 后 56.3%（404/717）的患者发生 SIRS。在接受后扩张（SIRS 34.7%（140/404）与无 SIRS 23.3%（73/313）；p<0.001）和大血管并发症（SIRS 16.1%（65/404）与无 SIRS 8.6%（27/313）；p=0.004）的患者中更常发生 SIRS。此外，发生 SIRS 的患者 ICU 天数更多（SIRS 1.56±1.50 天 vs. 无 SIRS 1.22±1.02 天；p=0.001）。在整个人群中，2 年全因死亡率为 23.9%。然而，1 年 CHF 无差异（5.9%vs.4.1%；log-rank=0.347），2 年全因死亡率也无差异（22.0%vs.26.2%；log-rank=0.690）。
SIRS 是 TAVI 后的常见表现，可能会延长住院时间，但在 2 年随访期间对死亡率没有影响。
