Al-Attar Nawwar, Himbert Dominique, Descoutures Fleur, Iung Bernard, Raffoul Richard, Messika-Zeitoun David, Brochet Eric, Francis Fady, Ibrahim Hassan, Vahanian Alec, Nataf Patrick
Assistance Publique-Hôpitaux de Paris, Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, Paris, France.
Ann Thorac Surg. 2009 Jun;87(6):1757-62; discussion 1762-3. doi: 10.1016/j.athoracsur.2009.03.047.
We describe the results of transcatheter aortic valve implantation (TAVI) in high-risk patients with aortic stenosis. Transfemoral access was the first option, and if contraindicated, the transapical approach was used.
Fifty patients were consecutively treated with TAVI because of high surgical risk or contraindications to operation. Mean age was 83 +/- 6 years, and most were in New York Heart Association classes III and IV. The predicted surgical mortality was 28% +/- 14% using the European System for Cardiac Operative Risk Evaluation and 16% +/- 7% using the Society of Thoracic Surgeons Predicted Risk of Mortality. The Edwards-SAPIEN (Edwards Lifesciences Inc, Irvine, CA) valve was implanted using a transfemoral approach in 35 patients and the transapical approach in 15. The transapical patients had more comorbidity (diabetes, previous myocardial infarction, previous coronary artery bypass grafting, peripheral artery disease, renal failure, porcelain aorta, and previous stroke).
Successful implantation was 85.7% and 100% in the transfemoral and transapical group, respectively. Gradients were satisfactory. In-hospital mortality was 8% in the transfemoral and 27% in the transapical group. Stroke was only observed in the transfemoral group. Overall 1-year survival was 74% +/- 11% in the transfemoral group and 60% +/- 13% in the transapical.
The results attributed to each approach (transfemoral or transapical) are strongly influenced by the selection strategy. Patients in the transapical group had more comorbidity and consequently a more critical early postoperative period. The respective places of transfemoral and transapical approaches need to be clarified for each approach by a randomized study.
我们描述了经导管主动脉瓣植入术（TAVI）在高危主动脉瓣狭窄患者中的结果。经股动脉入路是首选，如果有禁忌，则采用经心尖入路。
50例患者因手术风险高或手术禁忌而连续接受TAVI治疗。平均年龄为83±6岁，大多数患者处于纽约心脏协会心功能Ⅲ级和Ⅳ级。使用欧洲心脏手术风险评估系统预测的手术死亡率为28%±14%，使用胸外科医师协会预测的死亡风险为16%±7%。35例患者采用经股动脉入路植入爱德华兹-赛沛（Edwards Lifesciences Inc，加利福尼亚州欧文市）瓣膜，15例采用经心尖入路。经心尖入路的患者合并症更多（糖尿病、既往心肌梗死、既往冠状动脉搭桥术、外周动脉疾病、肾衰竭、瓷化主动脉和既往中风）。
经股动脉组和经心尖组的成功植入率分别为85.7%和100%。压力阶差令人满意。经股动脉组的住院死亡率为8%，经心尖组为27%。仅在经股动脉组观察到中风。经股动脉组的总体1年生存率为74%±11%，经心尖组为60%±13%。
每种入路（经股动脉或经心尖）的结果受选择策略的影响很大。经心尖组的患者合并症更多，因此术后早期情况更危急。需要通过随机研究明确每种入路中经股动脉和经心尖入路各自的地位。
