Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.
Cardiocare Clinica Cardiológica, Curitiba, PR - Brasil.
Arq Bras Cardiol. 2024 Sep;121(5):e20230551. doi: 10.36660/abc.20230551.
Transcatheter aortic valve implantation (TAVI) has had an exponential increase of its indication, being incorporated into the Brazilian Unified Public Health System in 2022, thus requiring assessment of its use in Brazil.
To assess the factors associated with in-hospital mortality and non-fatal complications in both genders in the Brazilian Registry of Transcatheter Aortic Valve Implantation and New Technologies (RIBAC-NT) population.
Analysis of the RIBAC-NT database from 2008 to 2022 was performed. Logistic models and machine learning were used for statistical assessment of the association between variables and outcomes. The software R was used and a 5% significance level, adopted.
Analysis of 2588 patients (women, 51.2%; in-hospital death, 8.2%). Mortality was associated with procedural complications, of which major vascular complication (VC) and acute kidney injury (AKI) stood out (p<0.001). Major VC occurred in 6% of the patients, with 34% mortality; AKI occurred in 8.8%, with 13% mortality, which increased up to 8 times when AKI coexisted with other complications. Non-fatal complications occurred in 50.5% of all patients, affecting 63% of those with 1st generation (1G) bioprosthesis and 39% of those with 2nd generation (2G) bioprosthesis (p<0,001). Non-femoral access and heart rhythm influenced non-fatal complications in patients with 1G prostheses, while complications in patients with 2G prosthesis associated with the female gender (39.6% vs. 30.4%, p=0.003).
In-hospital mortality in the RIBAC-NT population was directly associated with procedural complications, mainly major VC and AKI. The occurrence of non-fatal complications differed according to gender and bioprosthesis type.
经导管主动脉瓣植入术（TAVI）的适应证呈指数级增长，于 2022 年被纳入巴西统一公立卫生系统，因此需要评估其在巴西的应用情况。
评估巴西经导管主动脉瓣植入术和新技术注册研究（RIBAC-NT）人群中两性患者住院期间死亡率和非致命性并发症的相关因素。
对 2008 年至 2022 年 RIBAC-NT 数据库进行分析。使用逻辑模型和机器学习对变量与结局之间的相关性进行统计评估。使用 R 软件，采用 5%的显著性水平。
共分析了 2588 例患者（女性占 51.2%；住院期间死亡 8.2%）。死亡率与手术并发症相关，其中主要血管并发症（VC）和急性肾损伤（AKI）最为突出（p<0.001）。6%的患者发生主要 VC，死亡率为 34%；8.8%的患者发生 AKI，死亡率为 13%，当 AKI 与其他并发症同时存在时，死亡率增加 8 倍。所有患者中非致命性并发症发生率为 50.5%，第一代（1G）生物假体患者中发生率为 63%，第二代（2G）生物假体患者中发生率为 39%（p<0.001）。非股动脉入路和心律影响 1G 假体患者的非致命性并发症，而 2G 假体患者的并发症与女性性别相关（39.6%比 30.4%，p=0.003）。
RIBAC-NT 人群的住院期间死亡率与手术并发症直接相关，主要是主要 VC 和 AKI。非致命性并发症的发生因性别和生物假体类型而异。
