Liu Zeyu, Aguayo Esteban, Porter Giselle, Ali Konmal, Zinoviev Radoslav, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, USA.
Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, USA.
Clinics (Sao Paulo). 2025 Aug 5;80:100741. doi: 10.1016/j.clinsp.2025.100741.
While Transcatheter Aortic Valve Replacement (TAVR) is increasingly performed in patients with severe aortic stenosis, the impact of Hematologic Malignancies (HM) on associated outcomes, remains unclear. The authors The authors used a contemporary national database to investigate whether HM is associated with adverse clinical and financial outcomes following elective TAVR.
The authors The authors identified all adult (≥ 18-years) hospitalizations for elective TAVR in the 2016-2021 Nationwide Readmissions Database. Multivariable models were constructed to evaluate the association of HM with in-hospital mortality, major complications, non-home discharge, Length of Stay (LOS), index hospitalization costs, and 30-/90-day non-elective readmissions.
Of an estimated 336,998 TAVR procedures, 6123 (1.8 %) involved patients with HM. After risk adjustment, HM was not linked to in-hospital mortality (AOR = 0.96; 95 % CI 0.65-1.40; p = 0.82) or major complications, but conferred a modestly prolonged LOS (β+0.12 days; 95 % CI 0.01-0.25; p = 0.04) and increased costs (β+$1300; 95 % CI $400-$2300; p = 0.01). Moreover, HM was associated with higher odds of 30-day (AOR = 1.27; 95 % CI 1.13-1.42; p < 0.001) and 90-day (AOR = 1.33; 95 % CI 1.20-1.48; p < 0.001) non-elective readmissions. Notably, among 217 HM patients with a history of stem cell transplantation, in-hospital mortality risk was substantially elevated (AOR = 7.7; 95 % CI 1.53-38.8; p = 0.01).
In conclusion, although HM did not adversely impact in-hospital mortality or major complications following TAVR, it was linked to modestly increased resource utilization and readmission. Patients with prior stem cell transplantation represent a particularly vulnerable subgroup, underscoring the need for multidisciplinary pre-operative evaluation and specialized perioperative care pathways.
虽然经导管主动脉瓣置换术（TAVR）在重度主动脉瓣狭窄患者中越来越多地开展，但血液系统恶性肿瘤（HM）对相关结局的影响仍不明确。作者使用了一个当代国家数据库来调查HM是否与择期TAVR后的不良临床和经济结局相关。
作者在2016 - 2021年全国再入院数据库中识别出所有因择期TAVR住院的成年（≥18岁）患者。构建多变量模型以评估HM与住院死亡率、主要并发症、非回家出院、住院时间（LOS）、首次住院费用以及30/90天非择期再入院之间的关联。
在估计的336,998例TAVR手术中，6123例（1.8%）涉及HM患者。经过风险调整后，HM与住院死亡率（调整后比值比[AOR]=0.96；95%置信区间[CI] 0.65 - 1.40；p = 0.82）或主要并发症无关，但导致住院时间适度延长（β+0.12天；95% CI 0.01 - 0.25；p = 0.04）且费用增加（β+$1300；95% CI $400 - $2300；p = 0.01）。此外，HM与30天（AOR = 1.27；95% CI 1.13 - 1.42；p < 0.001）和90天（AOR = 1.33；95% CI 1.20 - 1.48；p < 0.001）非择期再入院的较高几率相关。值得注意的是，在217例有干细胞移植史的HM患者中，住院死亡风险大幅升高（AOR = 7.7；95% CI 1.53 - 38.8；p = 0.01）。
总之，虽然HM对TAVR后的住院死亡率或主要并发症没有不利影响，但它与资源利用适度增加和再入院相关。有既往干细胞移植史的患者是一个特别脆弱的亚组，这突出了多学科术前评估和专门围手术期护理路径的必要性。
