Marghitu Theodore, Roberts Sophia H, He June, Kouchoukos Nicholas, Kachroo Puja, Roberts Harold, Damiano Ralph, Zajarias Alan, Sintek Marc, Lasala John, Brescia Alexander A, Kaneko Tsuyoshi
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo.
Division of Cardiology, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Mo.
J Thorac Cardiovasc Surg. 2025 Aug;170(2):468-475.e2. doi: 10.1016/j.jtcvs.2024.10.046. Epub 2024 Nov 7.
Use of the Heart Team has been the standard of care for the treatment of aortic valve disease; however, its efficacy has not been evaluated. We sought to analyze its impact using the transcatheter aortic valve replacement (TAVR) use ratio (number of TAVR/total aortic valve replacement [AVR] volume) on TAVR, surgical aortic valve replacement (SAVR), and overall AVR outcomes.
We analyzed all TAVRs and SAVRs sampled by the National Readmissions Database between 2016 and 2020. Hospitals were stratified into quartiles on the basis of their TAVR/AVR ratio. Centers with a ratio below the first quartile were considered "low ratio," centers in the second and the third quartile "balanced ratio," and centers above the third quartile "high ratio." Primary outcomes were 30-day mortality and complication rate, which included stroke, renal failure, heart block, pacemaker placement, and valve regurgitation.
For overall AVR outcomes, centers with a balanced ratio had lower mortality compared with centers with low ratio (1.9% vs 2.1%, P = .01) and lower complication rate compared with centers with high ratio (34.8% vs 36.8%, P < .001). Centers with a balanced ratio had lower TAVR complication rate compared with centers with low ratio (37.3% vs 39%, P < .001). For SAVR outcome, centers with an balanced ratio had lower post-SAVR mortality (2.1% vs 2.6%, P < .001) and complication rate (28.6% vs 30.3%, P < .001) than centers with high ratio.
Centers with balanced TAVR ratios had superior outcomes compared with centers with low or high ratios. These data support the use of a balanced Heart Team to optimize AVR outcomes.
心脏团队的应用一直是主动脉瓣疾病治疗的护理标准；然而，其疗效尚未得到评估。我们试图通过经导管主动脉瓣置换术（TAVR）使用比例（TAVR数量/主动脉瓣置换术[AVR]总量）来分析其对TAVR、外科主动脉瓣置换术（SAVR）以及总体AVR结局的影响。
我们分析了2016年至2020年间国家再入院数据库抽取的所有TAVR和SAVR病例。医院根据其TAVR/AVR比例分为四分位数。比例低于第一四分位数的中心被视为“低比例”中心，第二和第三四分位数的中心为“平衡比例”中心，高于第三四分位数的中心为“高比例"中心。主要结局为30天死亡率和并发症发生率，并发症包括中风肾衰竭、心脏传导阻滞、起搏器植入和瓣膜反流。
对于总体AVR结局，平衡比例中心的死亡率低于低比例中心（1.9%对2.1%，P = 0.01），并发症发生率低于高比例中心（34.8%对36.8%，P < 0.001）。平衡比例中心的TAVR并发症发生率低于低比例中心（37.3%对39%，P < 0.001）。对于SAVR结局，平衡比例中心的SAVR术后死亡率（2.1%对2.6%，P < 0.001）和并发症发生率（28.6%对30.3%，P < 0.）低于高比例中心。
与低比例或高比例中心相比，TAVR比例平衡的中心结局更佳。这些数据支持使用平衡的心脏团队来优化AVR结局。
