背景:球囊主动脉瓣成形术(BAV)作为主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)的桥梁获得了新的兴趣。然而,尚不清楚患者是否应直接接受TAVR或在不清楚TAVR之前接受与BAV的分阶段桥接.我们使用国家数据库来检查TAVR患者中BAV和TAVR之间的关联及其对住院死亡率的影响。
方法:使用日本所有心脏和血管疾病注册的全国住院数据库以及诊断程序组合的组合,我们回顾性分析了2013年10月至2021年3月期间接受TAVR的27,600例AS患者.将直接TAVR组(n=27,387)的结果与BAV桥到TAVR组(n=213)的结果进行比较,在TAVR之前至少1天接受BAV。
结果:中位年龄为85(四分位距:82-88)岁,男性占33.3%(n=9188)。TAVR增加了计划外/紧急入院,而BAV桥对TAVR的使用减少。住院死亡率为1.3%,并随着时间的推移而下降。然而,BAV桥与TAVR的住院死亡率明显高于直接TAVR(5.6%与1.3%;p<0.0001)。与住院死亡率相关的因素包括年龄,身体质量指数,慢性肾病,经皮冠状动脉介入治疗,和BAV桥到TAVR。
结论:在计划外/紧急和计划的入院设置中,BAV桥接TAVR的院内死亡率比直接TAVR的院内死亡率差。应提出BAV到TAVR的实用标准,以改善结果。
BACKGROUND: Balloon aortic valvuloplasty (BAV) has gained renewed interest as a bridge to transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis (AS). However, it is unclear whether they patients should undergo TAVR directly or receive a staged bridge to BAV before TAVR is unclear. We used a national database to examine the association between BAV and TAVR in patients with TAVR and its effect on in-hospital mortality.
METHODS: Using the nationwide inpatient database of the Japanese registry of all cardiac and vascular diseases and the combination of the diagnosis procedure combination, we retrospectively analyzed 27,600 patients with AS who underwent TAVR between October 2013 and March 2021. Outcomes of the direct TAVR group (n = 27,387) were compared with those of the BAV bridge to TAVR group (n = 213), which received BAV at least 1 day before TAVR.
RESULTS: The median age was 85 (interquartile range: 82-88) years, with 33.3% (n = 9188) being male. Unplanned/emergent admissions increased with TAVR, whereas the use of BAV bridge to TAVR decreased. The in-hospital mortality rate was 1.3% and decreased over time. However, the BAV bridge to TAVR had a significantly higher in-hospital mortality than direct TAVR (5.6% vs. 1.3%; p < .0001). Factors associated with in-hospital mortality included age, body mass index, chronic renal disease, percutaneous coronary intervention, and BAV bridge to TAVR.
CONCLUSIONS: In unplanned/emergent and planned admission settings, the in-hospital mortality rate for BAV bridge to TAVR is worse than that for direct TAVR. Practical criteria for BAV bridge to TAVR should be proposed to improve outcomes.