TAVR vs balloon aortic valvotomy for severe aortic stenosis and cardiogenic shock: An insight from the National Inpatient Sample database.

Autor: Llah ST; CHI Saint Vincent Infirmary, 2 St Vincent Cir, Little Rock, AR 72205, USA. Electronic address: sibghat048@gmail.com., Sharif S; CHI Saint Vincent Hospital, 300 Werner St, Hot Springs, AR 71913, USA., Ullah S; International Medical College, Medical College Rd, Tongi 1711, Bangladesh., Sheikh SA; ECU Health North Hospital, 250 Smith Church Rd, Roanoke Rapids, NC 27870, USA., Shah MA; Government Medical College, Karan Nagar, Srinagar, Jammu and Kashmir, India., Shafi OM; University of Arkansas for Medical Sciences, 2801 S University Ave, Little Rock, AR 72204, USA., Dar T; University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, USA.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2023 Oct; Vol. 55, pp. 1-7. Date of Electronic Publication: 2023 May 12.
DOI: 10.1016/j.carrev.2023.05.006
Abstrakt: Background: Severe Aortic stenosis (AS) complicated by cardiogenic shock (CS) represents a grave clinical condition with limited treatment options. Evidence from small observation studies favors that Transcatheter Aortic Valve Replacement (TAVR) might be a feasible option in these patients in contrast to emergent Balloon Aortic Valvuloplasty (BAV) which is associated with very high short and long-term mortality.
Methods: 11,405 hospitalizations with severe AS complicated by CS between 2016 and 2020 were identified using the National Inpatient Sample (NIS) Database, and patients were then stratified according to whether they received TAVR or BAV. Propensity-score matching was used to account for differences in the baseline characteristics. Primary and secondary outcomes were then compared between 3485 hospitalizations in direct TAVR group and with 3485 matched hospitalizations in the BAV group. The primary outcome was a composite of all-cause in-hospital death, acute cerebrovascular accident (CVA), and myocardial infarction (MI). Secondary outcomes and safety outcomes were also compared between the two groups.
Results: TAVR was associated with fewer primary outcomes events as compared to BAV {36.8 % vs 56.8 %, aOR (95%CI) = 0.38(0.30-0.47)}, due to fewer all-cause in-hospital deaths {17.8 % vs 38.9 %, aOR (95%CI) =0.34 (0.26-0.43)} and MI {12.3 % vs 32.4 %, aOR (95%CI) = 0.29 (0.22-0.39)}. TAVR was associated with higher rates of acute CVA {6.17 % vs 3.44 %, aOR (95%CI) = 1.84 (1.08-3.21)} and pacemaker implantation post procedure {11.9 % vs 6.03 %, aOR (95%CI) = 2.10 (1.41-3.18)}.
Conclusion: Direct TAVR in shock and severe Aortic stenosis is a better strategy than rescue Balloon aortic valvotomy.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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