高危或手术禁忌患者行经皮球囊主动脉瓣成形术的并发症及转归。

Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients.

机构信息

Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.

出版信息

JACC Cardiovasc Interv. 2010 Nov;3(11):1150-6. doi: 10.1016/j.jcin.2010.08.014.

DOI:10.1016/j.jcin.2010.08.014

PMID:21087751

Abstract

OBJECTIVES

This study aimed to determine the success, complications, and survival of patients after balloon aortic valvuloplasty (BAV).

BACKGROUND

The introduction of transcatheter aortic valve implantation (TAVI) BAV has led to a revival in the treatment of patients with severe aortic stenosis.

METHODS

A cohort of 262 patients with severe aortic stenosis underwent 301 BAV procedures. Of these, 39 (14.8%) patients had ≥2 BAV procedures. Clinical, hemodynamic, and follow-up mortality data were collected.

RESULTS

The cohort mean age was 81.7 ± 9.8 years, and the mean Society of Thoracic Surgeons and logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 13.3 ± 6.7 and 45.6 ± 21.6, respectively. BAV was performed as a bridge to TAVI or to surgical aortic valve replacement in 28 patients (10.6%) and for symptom relief in 234 (89.4%). The mean aortic valve area (AVA) increased from 0.58 ± 0.3 cm(2) to 0.96 ± 0.3 cm(2) (p < 0.001). Of these, 111 (45.0%) had final AVA >1 cm(2), and in 195 patients (79%), AVA increased by >40%. De novo BAV resulted in a higher mean increase in AVA 0.41 ± 0.24 cm(2) versus 0.28 ± 0.24 cm(2) in redo BAV (p = 0.003). Serious adverse events occurred in 47 patients (15.6%), intraprocedural death in 5 (1.6%), stroke in 6 (1.99%), coronary occlusion in 2 (0.66%), severe aortic regurgitation in 4 (1.3%), resuscitation/cardioversion in 5 (1.6%), tamponade in 1 (0.33%), and permanent pacemaker in 3 (0.99%). A vascular complication occurred in 21 patients (6.9%); 34 (11.3%) had a post-procedure rise in creatinine >50%; and 3 (0.99%) required hemodialysis. During median follow-up of 181 days, the mortality rate was 50% (n = 131). The mortality rate in the group with final AVA >1 cm(2) was significantly lower than in the group with final AVA of <1 cm(2) (36.4% vs. 57.9%, p < 0.001). Final AVA was associated with lower mortality (hazard ratio: 0.46, p = 0.03). BAV as a bridge to TAVI or surgical aortic valve replacement had a better outcome compared with BAV alone: mortality rate 7 (25%) versus 124 (52.9%), respectively (p < 0.0001).

CONCLUSIONS

Long-term survival is poor after BAV alone. BAV as a bridge to percutaneous or surgical aortic valve replacement is feasible, safe, and associated with better outcome than BAV alone.

摘要

目的

本研究旨在确定球囊主动脉瓣成形术（BAV）后患者的成功率、并发症和存活率。

背景

经导管主动脉瓣植入术（TAVI）的引入导致了严重主动脉瓣狭窄患者治疗的复兴。

方法

一组 262 名严重主动脉瓣狭窄患者接受了 301 次 BAV 手术。其中，39 名（14.8%）患者接受了≥2 次 BAV 手术。收集了临床、血液动力学和随访死亡率数据。

结果

该队列的平均年龄为 81.7±9.8 岁，平均胸外科医师协会和逻辑欧洲心脏手术风险评估（EuroSCORE）分别为 13.3±6.7 和 45.6±21.6。28 名患者（10.6%）进行 BAV 作为 TAVI 或外科主动脉瓣置换的桥接治疗，234 名患者（89.4%）进行 BAV 以缓解症状。主动脉瓣口面积（AVA）从 0.58±0.3cm2 增加到 0.96±0.3cm2（p<0.001）。其中，111 名（45.0%）最终 AVA>1cm2，195 名患者（79%）AVA 增加>40%。新的 BAV 导致平均 AVA 增加 0.41±0.24cm2，而再次 BAV 导致平均 AVA 增加 0.28±0.24cm2（p=0.003）。47 名患者（15.6%）发生严重不良事件，5 名（1.6%）术中死亡，6 名（1.99%）发生中风，2 名（0.66%）发生冠状动脉闭塞，4 名（1.3%）发生严重主动脉瓣反流，5 名（1.6%）需要复苏/电复律，1 名（0.33%）发生心脏压塞，3 名（0.99%）需要永久性起搏器。21 名患者（6.9%）发生血管并发症；34 名患者（11.3%）术后肌酐升高>50%；3 名患者（0.99%）需要血液透析。在中位数为 181 天的随访期间，死亡率为 50%（n=131）。最终 AVA>1cm2 的患者死亡率明显低于最终 AVA<1cm2 的患者（36.4%比 57.9%，p<0.001）。最终 AVA 与较低的死亡率相关（风险比：0.46，p=0.03）。BAV 作为 TAVI 或外科主动脉瓣置换的桥接治疗与单独 BAV 相比具有更好的结局：死亡率分别为 7（25%）和 124（52.9%）（p<0.0001）。