≥90岁严重主动脉瓣狭窄患者经导管介入治疗的可行性：再探主动脉瓣球囊成形术

Feasibility of transcatheter intervention for severe aortic stenosis in patients >or=90 years of age: aortic valvuloplasty revisited.

作者信息

Pedersen Wes R, Klaassen Paul J, Boisjolie Charlene R, Pierce Talia A, Harris Kevin M, Lesser John R, Hara Hidehiko, Mooney Michael R, Graham Kevin J, Kshettry Vibhu R, Goldenberg Irvin F, Priztker Marc R, Van Tassel Robert A, Schwartz Robert S

机构信息

Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.

出版信息

Catheter Cardiovasc Interv. 2007 Jul 1;70(1):149-54. doi: 10.1002/ccd.21161.

DOI:10.1002/ccd.21161

PMID:17503515

Abstract

OBJECTIVES

The goals of this study were to determine the feasibility, safety, and early outcomes of balloon aortic valvuloplasty (BAV) for severe aortic stenosis in a nonagenarian population.

BACKGROUND

This very elderly population is expanding rapidly, has a high incidence of aortic stenosis, and uncommonly undergoes surgical aortic valve replacement. These patients may best be treated with a transcatheter approach due to comorbidities, surgical risk, and personal preference.

METHODS

We reviewed 31 consecutive patients >or=90 years of age who underwent BAV at our institution from July 2003 to August 2006 for data pertinent to patient characteristics, procedural techniques, and 30-day outcomes.

RESULTS

Our patients had a mean age of 93 +/- 3.0 years (90-101). The society of thoracic surgery risk score was 18.5 (+/-10.2) and logistic Euroscore was 35.8 (+/-19.3). Twenty-five patients (81%) underwent retrograde BAV and 6 (19%) antegrade BAV. Five patients (16%) underwent combined BAV and coronary stenting. Overall mean aortic valve area increased from 0.52 cm2 (+/-0.17) to 0.92 cm2 (+/-0.22) and mean New York Heart Association (NYHA) functional class improved from 3.4 to 1.8. Intraprocedural mortality occurred in one patient (3.2%) and 30-day mortality in three patients (9.7%).

CONCLUSIONS

BAV can be carried out in high risk nonagenarian patients with an acceptable complication rate, low perioperative mortality, and early improvement in NYHA functional class.

摘要

目的

本研究的目的是确定球囊主动脉瓣成形术（BAV）用于非agenarian人群严重主动脉瓣狭窄的可行性、安全性和早期结果。

背景

这个非常老年的人群正在迅速扩大，主动脉瓣狭窄发病率高，并且很少接受外科主动脉瓣置换术。由于合并症、手术风险和个人偏好，这些患者可能最好采用经导管方法治疗。

方法

我们回顾了2003年7月至2006年8月在我们机构接受BAV的31例年龄≥90岁的连续患者，以获取与患者特征、手术技术和30天结果相关的数据。

结果

我们的患者平均年龄为93±3.0岁（90 - 101岁）。胸外科协会风险评分是18.5（±10.2），逻辑欧洲评分是35.8（±19.3）。25例患者（81%）接受逆行BAV，6例（19%）接受顺行BAV。5例患者（16%）接受BAV联合冠状动脉支架置入术。总体平均主动脉瓣面积从0.52 cm²（±0.17）增加到0.92 cm²（±0.22），纽约心脏协会（NYHA）功能分级平均从3.4改善到1.8。术中死亡1例患者（3.2%），30天死亡3例患者（9.7%）。