Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Polyvascular Disease.

IF 3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology and Therapy Pub Date : 2025-05-18 DOI:10.1007/s40119-025-00415-7

Abdelrhman Abomoawad, Ramy Sedhom, Harsh Golwala, Mohamed Abdelazeem, Mamas Mamas, Hani Jneid, Anthony A Bavry, Dharam J Kumbhani, Samir Kapadia, Ayman Elbadawi

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引用次数: 0

Abstract

Introduction: There is a paucity of data regarding the trends and comparative outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) among patients with polyvascular disease (PVD).

Methods: The Nationwide Readmissions Database (2016-2020) was queried for patients undergoing AVR. Propensity score matching was used to compare the outcomes of TAVR versus SAVR among patients with PVD, and for comparing TAVR among those with versus without PVD. The primary outcome was in-hospital mortality.

Results: The final cohort included 545,409 hospitalizations for AVR. During the study years, there was an increase in the utilization of TAVR versus SAVR among patients with PVD. Patients with PVD undergoing TAVR were older and more likely to be women compared with patients with PVD undergoing SAVR. Compared with SAVR, patients with PVD undergoing TAVR had lower odds of in-hospital mortality (adjusted odds ratio (aOR) 0.26; 95% confidence interval (CI) 0.19-0.35), acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, and major bleeding, but higher odds of pacemaker and non-elective 90-day readmissions (aOR 1.13; 95% CI 1.01-1.26). TAVR among patients with versus without PVD showed similar in-hospital mortality (aOR 1.10; 95% CI 0.94-1.20), while there were higher odds of AMI, ischemic stroke, and vascular complications after TAVR in patients with PVD. A higher burden of atherosclerotic vascular beds conferred higher mortality with SAVR more than with TAVR, while a higher burden of atherosclerotic vascular beds conferred a higher risk of ischemic stroke and readmissions after both TAVR and SAVR.

Conclusions: Nationwide data demonstrated that patients with PVD who undergo TAVR were associated with lower in-hospital mortality and major cardiovascular complications compared with those who undergo SAVR. Patients with PVD have similar mortality to those with no PVD undergoing TAVR, but were associated with a higher risk for complications and readmission.

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多血管疾病患者经导管与手术主动脉瓣置换术的比较。

在多血管疾病（PVD）患者中，关于经导管主动脉瓣置换术（TAVR）与外科主动脉瓣置换术（SAVR）的趋势和比较结果的数据缺乏。方法：查询全国AVR再入院数据库（2016-2020）。倾向评分匹配用于比较PVD患者TAVR和SAVR的结果，以及比较有和无PVD患者TAVR的结果。主要终点是住院死亡率。结果：最终队列包括545,409例AVR住院患者。在研究期间，PVD患者中TAVR的使用率比SAVR的使用率有所增加。与接受SAVR的PVD患者相比，接受TAVR的PVD患者年龄更大，更可能是女性。与SAVR相比，接受TAVR的PVD患者住院死亡率较低(调整优势比（aOR） 0.26；95%可信区间（CI） 0.19-0.35)、急性心肌梗死（AMI）、缺血性卒中、出血性卒中和大出血，但起搏器和非选择性90天再入院的几率较高(aOR 1.13；95% ci 1.01-1.26)。有与无PVD患者的TAVR显示相似的住院死亡率(aOR 1.10；95% CI 0.94-1.20)，而PVD患者TAVR后AMI、缺血性卒中和血管并发症的发生率更高。与TAVR相比，较高的动脉粥样硬化血管床负担会增加SAVR患者的死亡率，而较高的动脉粥样硬化血管床负担会增加TAVR和SAVR患者缺血性卒中和再入院的风险。结论：全国范围内的数据表明，与接受SAVR的患者相比，接受TAVR的PVD患者住院死亡率和主要心血管并发症较低。接受TAVR的PVD患者与无PVD患者的死亡率相似，但并发症和再入院的风险更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiology and Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

5.30

自引率

0.00%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged. Areas of focus include, but are not limited to, ischaemic heart disease and acute cardiac care, myocardial, valvular, pericardial and congenital heart disease, vascular and pulmonary disease (including hypertension), arrhythmias, heart failure, non-invasive diagnostic techniques, and invasive and interventional cardiology as well as cardiovascular surgery. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols and short communications such as commentaries and editorials. Cardiolology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. Rapid Publication The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of cardiovascular therapies. Personal Service The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning authors will always have an editorial contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research. 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