Moreno Raul, Calvo Luis, Salinas Pablo, Dobarro David, Santiago Jimenez Valero, Sanchez-Recalde Angel, Galeote Guillermo, Riera Luis, Moreno-Gomez Isidro, Mesa Jose, Plaza Ignacio, Lopez-Sendon Jose
University Hospital La Paz, Interventional Cardiology (Diagonal, 1), Paseo La Castellana, 261. Diagonal 1, Madrid, 28046, Spain.
J Invasive Cardiol. 2011 May;23(5):180-4.
In order to improve technique and to prevent serious procedural complications during transcatheter aortic valve implantation (TAVI), it is crucial to identify the causes of death of patients undergoing this procedure.
The objective of this study was to identify the causes of death during the procedure and at 1 month in patients with severe aortic stenosis undergoing TAVI.
12 published studies with information about the causes of death in patients undergoing TAVI were selected. Overall, 1223 patients were included in these studies, and 249 deaths were reported (119 at 1 month and 130 at >1 month post-procedure). Mortality during the procedure and at 1 month was 2.3% and 9.7%, respectively. The proportion of cardiac deaths was higher at <1 month in comparison with >1 month (56% versus 34%, respectively; p = 0.001). At 1 month, the most frequent causes of death were cardiac failure/multi-organ failure (24%), sudden death/cardiac arrest (17%), vascular and bleeding complications (17%), stroke (11%), sepsis (11%), and cardiac tamponade (10%). During the procedure, the most frequent causes of death were cardiac tamponade (39%), cardiac failure (21%), cardiac arrest (18%), and vascular and/or bleeding complications (18%). In patients treated with the CoreValve system (Medtronic, Minneapolis, Minnesota) versus those treated with Edwards valves (Cribier-Edwards, Edwards-SAPIEN or SAPIEN XT valve, Edward Lifesciences, Irvine, California), deaths at 1 month due to vascular and bleeding complications were less frequent (3% versus 22%, respectively; p = 0.019), but those due to cardiac tamponade (26% versus 6%, respectively; p = 0.019), and because of aortic regurgitation (10% versus 0%, respectively; p = 0.03) were more frequent.
In this pooled analysis, mortality at 1 month after TAVI was 9.7%. The causes of death were widely variable, and of both cardiac and non-cardiac origin. There were some important differences between both devices in the cause of mortality.
为了改进经导管主动脉瓣植入术（TAVI）的技术并预防严重的手术并发症，确定接受该手术患者的死亡原因至关重要。
本研究的目的是确定接受TAVI的重度主动脉瓣狭窄患者在手术期间及术后1个月的死亡原因。
选择12项已发表的关于TAVI患者死亡原因的研究。这些研究共纳入1223例患者，报告了249例死亡（术后1个月内119例，术后>1个月130例）。手术期间及术后1个月的死亡率分别为2.3%和9.7%。与术后>1个月相比，术后<1个月心脏死亡的比例更高（分别为56%和34%；p = 0.001）。术后1个月，最常见的死亡原因是心力衰竭/多器官衰竭（24%）、猝死/心脏骤停（17%）、血管及出血并发症（17%）、卒中（11%）、脓毒症（11%）和心脏压塞（10%）。手术期间，最常见的死亡原因是心脏压塞（39%）、心力衰竭（21%）、心脏骤停（18%）以及血管和/或出血并发症（18%）。与使用爱德华兹瓣膜（Cribier-Edwards、Edwards-SAPIEN或SAPIEN XT瓣膜，爱德华生命科学公司，加利福尼亚州尔湾）治疗的患者相比，使用CoreValve系统（美敦力公司，明尼苏达州明尼阿波利斯）治疗的患者术后1个月因血管及出血并发症导致的死亡较少见（分别为3%和22%；p = 0.019），但因心脏压塞导致的死亡（分别为26%和6%；p = 0.019）以及因主动脉瓣反流导致的死亡（分别为10%和0%；p = 0.03）更常见。
在这项汇总分析中，TAVI术后1个月的死亡率为9.7%。死亡原因广泛多样，包括心脏和非心脏原因。两种器械在死亡原因方面存在一些重要差异。
