背景:胸部放疗已用于治疗胸内和纵隔肿瘤。胸壁照射(C-XRT)幸存者经常发展为瓣膜疾病,包括主动脉狭窄,这最终需要更换瓣膜。先前的试验显示手术主动脉瓣置换术的结果较差。然而,C-XRT患者经导管主动脉瓣置换术(TAVR)结局相关数据有限.
方法:从2016年至2020年查询了国家住院患者样本(NIS)数据库,以确定TAVR的成人住院情况。根据使用ICD-10-CM代码的C-XRT历史对其进行了二分。进行倾向得分匹配以得出年龄,性别,医院特色,和合并症与没有C-XRT病史的对照相匹配。研究的结果是住院死亡率和并发症,平均停留时间(LOS),医院总费用(THC)。采用多因素logistic回归和线性回归分析结果。
结果:在2016年至2020年期间接受TAVR的296,670例患者中,515例有C-XRT病史。在接受TAVR的患者的倾向评分匹配后,有C-XRT病史的患者显示出显著较低的住院死亡率校正几率(校正奇数比[aOR]0.04,95%CI[0.003-0.57],p=0.017),平均LOS降低1.6天(-1.88至-1.26天,p<0.001)和降低的平均THC(-$74,720,[-$88,784至-$60,655],p<0.001)。此外,C-XRT患者住院并发症的校正几率显著降低,主要是急性心肌梗死,脑血管事件,急性呼吸衰竭,急性肾损伤,需要血管加压药和心肺复苏,而并发症的几率相似,包括插管的要求,机械通气,血液透析,和心源性休克.
结论:我们的分析显示,调整后的住院死亡率降低,逗留时间,医院总费用,以及有C-XRT病史的接受TAVR的患者的住院并发症。TAVR在该人群亚组中似乎是安全可行的替代方案。
BACKGROUND: Chest radiotherapy has been utilized to treat intra-thoracic and mediastinal tumors. Chest wall irradiation (C-XRT) survivors frequently develop valvular disease, including aortic stenosis, which eventually requires valve replacement. Previous trials have shown worse outcomes with surgical aortic valve replacement. However, transcatheter aortic valve replacement (TAVR) outcomes-related data in patients with C-XRT is limited.
METHODS: The national inpatient sample (NIS) database was queried from 2016 to 2020 to identify adult hospitalizations with TAVR, which were dichotomized based on a history of C-XRT using ICD-10-CM codes. Propensity score matching was performed to derive age, sex, hospital characteristics, and co-morbidities matched controls without a history of C-XRT. The outcomes studied were inpatient mortality and complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression were used to analyze the outcomes.
RESULTS: Of 296,670 patients who underwent TAVR between 2016 and 2020, 515 had a history of C-XRT. Upon propensity score matching in patients undergoing TAVR, Patients with a history of C-XRT showed significantly lower adjusted odds of in-hospital mortality (adjusted odd ratio [aOR] 0.04, 95 % CI [0.003-0.57], p = 0.017), lower mean LOS by 1.6 days (-1.88 to -1.26 days, p < 0.001) and reduced mean THC (-$74,720, [-$88,784 to -$60,655], p < 0.001). Additionally, patients with C-XRT had significantly lower adjusted odds of inpatient complications, mainly acute myocardial infarction, cerebrovascular events, acute respiratory failure, acute kidney injury, need for vasopressors and cardiopulmonary resuscitation, whereas similar odds of complications, including a requirement of intubation, mechanical ventilation, hemodialysis, and cardiogenic shock.
CONCLUSIONS: Our analysis showed reduced adjusted odds of in-hospital mortality, length of stay, total hospital charges, and inpatient complications in patients undergoing TAVR with a history of C-XRT. TAVR appears to be a safe and viable alternative in this population subgroup.