Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
Eur J Cardiothorac Surg. 2011 Jul;40(1):49-55. doi: 10.1016/j.ejcts.2010.11.039. Epub 2011 Jan 12.
Trans-catheter aortic valve implantation (TAVI) is an alternative for patients not eligible for surgical aortic valve replacement. When peripheral access is not amenable by the transfemoral route (TF-TAVI), the most-used approaches are the trans-apical (TAp-TAVI) and the trans-axillary (TAx-TAVI). The aim of this study is to report the outcomes in a single-center series of consecutive patients treated by TAVI using the different approaches.
From November 2007 to June 2010, 177 patients underwent TAVI by the same multispeciality valve team. TAp-TAVI was performed in the operative room, while TF-TAVI and TAx-TAVI were done in the catheterization laboratory. Follow-up was 100% complete (mean 6.0 ± 6.8 months).
TF-TAVI, TAx-TAVI, and TAp-TAVI were performed in 140 (79.1%), 19 (10.7%), and 16 patients (9.1%), respectively. The groups were not different in terms of age (p = 0.6), left ventricular ejection fraction (LVEF) (p = 0.6), Log-EuroSCORE (European System for Cardiac Operative Risk Evaluation) (p = 0.3), and Society of Thoracic Surgeons (STS) score (p = 0.7), while peripheral artery disease was higher in the TAp-TAVI and TAx-TAVI groups compared with the TF-TAVI group (p < 0.0001). The Charlson score was 10.7 ± 14.9, 5.8 ± 1.2, and 5.9 ± 1.8 for TAp-TAVI, TAx-TAVI, and TF-TAVI, respectively (p = 0.02). In-hospital (30-day) mortality was 1.4% (2/140), 12.5% (2/16), and 5.3% (1/19) for TF, Tap, and TAx, respectively (p = 0.03). At follow-up, 6 months' actuarial survival was 72.2 ± 12.0%, 67.4 ± 17.4%, and 88.4±3.1% for TAp-TAVI, TAx-TAVI, and TF-TAVI, respectively (p = 0.3).
Similar to findings from recent, larger trials, patients undergoing TF-TAVI in high-risk patients had excellent 6-month results. Although TAx-TAVI was associated with lower hospital mortality, it shared the same 6-month outcomes of TAp-TAVI, probably due to a similar selection bias.
经导管主动脉瓣植入术（TAVI）是一种不适合外科主动脉瓣置换术的患者的替代治疗方法。当经股动脉途径（TF-TAVI）不可用时，最常用的方法是经心尖（TAp-TAVI）和经腋动脉（TAx-TAVI）。本研究旨在报告单一中心连续接受不同方法 TAVI 治疗的患者的结局。
从 2007 年 11 月至 2010 年 6 月，177 名患者由同一多专科瓣膜团队进行 TAVI。TAp-TAVI 在手术室进行，而 TF-TAVI 和 TAx-TAVI 在导管室进行。随访率为 100%（平均 6.0±6.8 个月）。
TF-TAVI、TAx-TAVI 和 TAp-TAVI 分别在 140 名（79.1%）、19 名（10.7%）和 16 名患者（9.1%）中进行。三组在年龄（p=0.6）、左心室射血分数（LVEF）（p=0.6）、Log-EuroSCORE（欧洲心脏手术风险评估系统）（p=0.3）和 STS 评分（p=0.7）方面无差异，而 TAp-TAVI 和 TAx-TAVI 组的外周动脉疾病发生率高于 TF-TAVI 组（p<0.0001）。Charlson 评分分别为 TAp-TAVI、TAx-TAVI 和 TF-TAVI 组的 10.7±14.9、5.8±1.2 和 5.9±1.8（p=0.02）。院内（30 天）死亡率分别为 TF-TAVI、TAp-TAVI 和 TF-TAVI 组的 1.4%（2/140）、12.5%（2/16）和 5.3%（1/19）（p=0.03）。在随访时，TAp-TAVI、TAx-TAVI 和 TF-TAVI 组的 6 个月生存率分别为 72.2±12.0%、67.4±17.4%和 88.4±3.1%（p=0.3）。
与最近更大规模的试验结果相似，高危患者行 TF-TAVI 后 6 个月结果良好。虽然 TAx-TAVI 与较低的院内死亡率相关，但与 TAp-TAVI 有相同的 6 个月结局，可能是由于相似的选择偏倚。
