Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital and Lund University, Lund, Sweden.
Ann Thorac Surg. 2011 Jan;91(1):57-63. doi: 10.1016/j.athoracsur.2010.07.072.
Transcatheter aortic valve implantation (TAVI) is a therapeutic option for high-risk patients with aortic stenosis. Procedural mortality remains high in comparison with conventional aortic valve replacement (AVR) because patients determined for TAVI are commonly denied conventional surgery. We aimed to evaluate access-related complications between the transfemoral (TF) and the transapical (TA) approach and to compare survival between TAVI and conventional AVR in propensity-score-matched patients.
Between January 2008 and November 2009, 40 patients underwent TAVI (TF, n=10; TA, n=30) with the Edwards Sapien bioprosthesis (Edwards Lifesciences, Irvine, CA). Survival and postoperative complications were evaluated between the TF and the TA approach. A comparison of survival was made between the TAVI patients and propensity-score-matched patients undergoing conventional AVR.
Successful implantation rate was 92.5% (37 of 40). Thirty-day mortality was 5.0% (2 of 40), and the overall in-hospital mortality was 10.0% (4 of 40). Survival after TAVI was 77% at both 6 months and 1 year. Major vascular complications occurred in 3 of 10 patients (all in the TF group), and 3 of 40 patients (7.5%) suffered cerebrovascular events. A comparison of survival between TAVI and propensity score-matched conventional AVR patients showed no significant difference in either the TA group (p=0.73) or the TF group (p=0.59).
The vascular complications occurring when using the TF approach were probably related to a combination of a wide introducer sheath and heavily calcified femoral arteries in a high-risk population. No serious complications were encountered when using the TA approach. After propensity-score matching, survival with both the TA and TF approaches is similar to that after AVR.
经导管主动脉瓣植入术（TAVI）是高危主动脉瓣狭窄患者的一种治疗选择。与传统主动脉瓣置换术（AVR）相比，TAVI 的程序死亡率仍然很高，因为 TAVI 确定的患者通常被拒绝接受传统手术。我们旨在评估经股（TF）和经心尖（TA）入路之间的血管相关并发症，并在倾向评分匹配的患者中比较 TAVI 和传统 AVR 的生存率。
2008 年 1 月至 2009 年 11 月，40 例患者接受了爱德华兹·萨皮恩生物瓣（爱德华兹生命科学公司，加利福尼亚州欧文）的 TAVI（TF，n=10；TA，n=30）。评估了 TF 和 TA 入路之间的生存率和术后并发症。比较了 TAVI 患者和接受传统 AVR 的倾向评分匹配患者的生存率。
成功植入率为 92.5%（37/40）。30 天死亡率为 5.0%（2/40），总住院死亡率为 10.0%（4/40）。TAVI 后 6 个月和 1 年的生存率分别为 77%。10 例患者中有 3 例（均在 TF 组）发生大血管并发症，40 例患者中有 3 例（7.5%）发生脑血管事件。TAVI 与倾向评分匹配的传统 AVR 患者的生存比较显示，在 TA 组（p=0.73）或 TF 组（p=0.59）均无显著差异。
在高危人群中，使用 TF 入路时发生的血管并发症可能与宽大的引入器鞘和严重钙化的股动脉有关。使用 TA 入路时没有发生严重并发症。在进行倾向评分匹配后，TA 和 TF 两种方法的生存率与 AVR 相似。
