1Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2011;69(2):105-14.
Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS).
To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement.
Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (<7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory.
Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03).
Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.
经导管主动脉瓣植入术（TAVI）是一种治疗主动脉瓣狭窄（AS）的新方法。
评估经股动脉/锁骨下动脉入路（TFA/TSA）或经心尖入路（TAA）在高危外科主动脉瓣置换术患者中应用 TAVI 的早期结果。
2009 年 1 月至 2010 年 5 月，30 例高危患者接受 TAVI。主要治疗选择是 TFA，如果 TFA 有禁忌症，则使用 TAA；1 例患者采用 TSA 进行手术。选择 TAA 的原因如下：髂股动脉直径小（<7mm）和/或严重钙化、周围动脉粥样硬化、“瓷器”主动脉和升主动脉水平行程。所有患者均使用 Edwards-Sapien 或 CoreValve 装置，在导管室不使用体外循环进行手术。
患者平均年龄 82.46 ± 5.79 岁，平均 NYHA 分级为 3.23 ± 0.41，使用 logistic Euroscore 预测的平均手术死亡率为 29.18 ± 16.9%（TFA/TSA 组为 22.72 ± 12.07%，TAA 组为 34.6 ± 15.4%；p = 0.031）。11 例患者接受 TAA 治疗。96%的患者成功植入瓣膜。院内死亡率为 3.3%。整个队列的 30 天死亡率为 6.6%，TFA/TSA 组为 0%，TAA 组为 18%。无围手术期心肌梗死（MI）、心源性休克、卒中和短暂性脑缺血发作或需要心肺复苏。1 例患者在术后 3 周突然死亡；除该例患者外，在 30 天随访时无主要不良心血管事件（MACCE：MI、脑血管意外、再手术）。两组主动脉最大跨瓣压差均显著降低（从术前 99.6 ± 22.07mmHg 降至术后 21.83 ± 9.38mmHg 和 30 天随访时 23.25 ± 9.22mmHg），无严重主动脉瓣反流。30 天时 NYHA 分级从 3.23 ± 0.41 改善至 1.72 ± 0.52（p = 0.03）。
我们的结果表明 TFA/TSA 组的 30 天并发症发生率和死亡率较低。在非外科高危严重 AS 患者中，多种瓣膜植入技术的应用，可能扩大了这一治疗方法的适应证人群。
