跨导管大动脉置换体积对末期脏病患者的结果的影响
Esteban Aguayo1, Oh Jin Kwon1, Mitchell Won1
1Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
The Annals of thoracic surgery
|August 29, 2025
概括
末期病患者在经过透气管大动脉置换 (TAVR) 后面临更高的死亡率和再入院风险. 这些风险不论医院的容量如何都会持续存在,强调需要仔细选择患者.
科学领域:
- 心血管医学
- 肝脏病学
- 干预心脏病学
背景情况:
- 末期病患者有较高的动脉狭窄风险.
- 在ESRD患者中,通过导管进行大动脉置换 (TAVR) 的疗效数据有限.
研究的目的:
- 在接受TAVR的ESRD患者中检查急性死亡率,并发症和30天再入院情况.
- 将ESRD和非ESRD群体之间的结果进行比较.
主要方法:
- 使用2016-2021年国家再入院数据库对TAVR入院者 (≥18岁) 的数据.
- 将患者分为ESRD和非ESRD组.
- 评估住院死亡率,30天再入院,术后并发症,住院时间和费用.
- 采用多变量后勤回归和尼尔森-阿伦分析,按机构TAVR量分层 (低体积与高体积医院).
主要成果:
- 在411,311名TAVR患者中,有7. 3%患有ESRD.
- 在风险调整后,ESRD与显著更高的死亡率 (AOR 1.79) 和再入院率 (AOR 1.87) 相关.
- ESRD患者住院时间较长 (+ 1.3 天),费用较高 (+ 1 万美元).
- 对于ESRD患者来说,机构TAVR容量没有减轻死亡或再入院风险.
结论:
- 接受TAVR的ESRD患者患有术后死亡和再入院的风险增加.
- 较高的TAVR程序体积中心并没有降低ESRD患者的这些高风险.
- 由于风险增加,对接受TAVR的ESRD患者进行仔细的选择和优化至关重要.
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