Aggarwal Abhinav, Jang Sun-Joo, Vardhan Swarnima, Webber Fabricio Malaguez, Alam Md Mashiul, Vardhan Madhurima, Lancaster Gilead I, Ahmad Yousif, Vora Amit N, Zarich Stuart W, Inglessis-Azuaje Ignacio, Elmariah Sammy, Forrest John K, Davila Carlos D
Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, Connecticut.
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Struct Heart. 2024 Jun 12;8(6):100327. doi: 10.1016/j.shj.2024.100327. eCollection 2024 Nov.
Liver cirrhosis is not included in surgical risk prediction models despite being a significant risk factor associated with high periprocedural morbidity and mortality in patients undergoing cardiac surgery. Limited contemporary data exists assessing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis.
Patients with cirrhosis who underwent TAVR or SAVR were identified from the Nationwide Readmissions Database. Propensity-score matched analysis was performed to compare the clinical characteristics, in-hospital, and 30-day outcomes between the two groups.
Between 2016 and 2019, 4047 patients with cirrhosis underwent TAVR (n = 3298) or SAVR (n = 749). TAVR adoption sharply rose, doubling the number of cases performed during the study period. Following propensity matching among 718 patients, the TAVR group consistently exhibited significantly lower rates of in-hospital mortality (2.2 vs. 7.5%; = 0.002), bleeding (14.5 vs. 52.9%; < 0.001), vascular complications (1.4 vs. 5%; = 0.011), hepatorenal syndrome (3.3 vs. 8.9%; = 0.003), cardiogenic shock (2.8 vs. 7%; = 0.015), mechanical circulatory support utilization (0.6 vs. 4.7%; = 0.001), 30-day all-cause readmission rates (10.3 vs. 18.1%; = 0.005), and 30-day unplanned readmission rates (10 vs. 16.6%; = 0.015) compared to the SAVR group. The TAVR group had significantly shorter median hospital stays, lower non-home disposition rates, and reduced hospital costs.
TAVR is associated with significantly lower rates of in-hospital mortality, bleeding, vascular complications, hepatorenal syndrome, cardiogenic shock, mechanical circulatory support utilization, and 30-day readmission rates compared to SAVR and represents a safe therapeutic option for aortic valve replacement in patients with cirrhosis.
尽管肝硬化是心脏手术患者围手术期高发病率和死亡率的一个重要危险因素，但它并未被纳入手术风险预测模型。目前评估肝硬化患者经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）结局的当代数据有限。
从全国再入院数据库中识别出接受TAVR或SAVR的肝硬化患者。进行倾向评分匹配分析，以比较两组患者的临床特征、住院期间及30天结局。
2016年至2019年期间，4047例肝硬化患者接受了TAVR（n = 3298）或SAVR（n = 749）。TAVR的应用急剧增加，使研究期间的病例数翻倍。在718例患者进行倾向匹配后，TAVR组的住院死亡率（2.2%对7.5%；P = 0.002）、出血（14.5%对52.9%；P < 0.001）、血管并发症（1.4%对5%；P = 0.011）、肝肾综合征（3.3%对8.9%；P = 0.003）、心源性休克（2.8%对7%；P = 0.015）、机械循环支持使用率（0.6%对4.7%；P = 0.001）、30天全因再入院率（10.3%对18.1%；P = 0.005）和30天非计划再入院率（10%对16.6%；P = 0.015）均显著低于SAVR组。TAVR组的中位住院时间显著缩短，非回家处置率降低，住院费用减少。
与SAVR相比，TAVR的住院死亡率、出血、血管并发症、肝肾综合征、心源性休克、机械循环支持使用率及30天再入院率均显著降低，是肝硬化患者主动脉瓣置换的一种安全治疗选择。
