Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):e47-52. doi: 10.1016/j.jtcvs.2011.02.045. Epub 2011 May 17.
Aortic valve replacement remains the standard treatment for symptomatic severe aortic stenosis. However, catheter-based approaches have recently emerged as therapeutic options for high-risk surgical candidates. The objective of this study is to use propensity scoring to compare early clinical outcomes after transapical aortic valve implantation and conventional aortic valve replacement.
Propensity scoring based on logistic regression modeling of 16 preoperative patient characteristics was used to identify a group of very high-risk patients undergoing isolated conventional aortic valve replacement comparable to those patients undergoing transapical aortic valve implantation. McNemar's test was used to compare early clinical outcomes between the 2 treatment groups, including 30-day mortality and in-hospital postoperative complications.
Ninety-two patients receiving transapical aortic valve implantation between October 2005 and April 2010 met inclusion criteria for this study. Half of these patients were successfully matched 1:1 to a patient receiving conventional aortic valve replacement. Baseline characteristics were similar between the 2 treatment groups after propensity matching. There were 4 perioperative deaths (8.7%) in the conventional aortic valve replacement group and 6 perioperative deaths (13%) in the transapical aortic valve implantation group (P > .05). There were no significant differences in the rates of cerebrovascular accidents, wound infections, reoperation for bleeding, or length of postoperative hospital stay between the 2 groups (P > .05).
Among high-risk propensity-matched patients, early clinical outcomes are similar after transapical aortic valve implantation and conventional aortic valve replacement. However, given the likelihood of residual selection bias, a prospective randomized trial is necessary to adequately compare the clinical outcomes after these 2 aortic valve procedures.
主动脉瓣置换术仍然是治疗有症状的严重主动脉瓣狭窄的标准治疗方法。然而，最近出现了经导管方法作为高危手术患者的治疗选择。本研究的目的是使用倾向评分比较经心尖主动脉瓣植入术和传统主动脉瓣置换术的早期临床结果。
使用基于逻辑回归模型的 16 项术前患者特征的倾向评分，确定一组接受单纯传统主动脉瓣置换术的极高危患者，与接受经心尖主动脉瓣植入术的患者相匹配。使用 McNemar 检验比较 2 组治疗的早期临床结果，包括 30 天死亡率和住院术后并发症。
2005 年 10 月至 2010 年 4 月期间接受经心尖主动脉瓣植入术的 92 例患者符合本研究的纳入标准。这些患者中有一半成功地与接受传统主动脉瓣置换术的患者 1:1 匹配。倾向匹配后，2 组治疗的基线特征相似。在传统主动脉瓣置换组中有 4 例围手术期死亡（8.7%），在经心尖主动脉瓣植入组中有 6 例围手术期死亡（13%）（P>.05）。2 组之间的脑血管意外、伤口感染、因出血再次手术或术后住院时间的发生率无显著差异（P>.05）。
在高危倾向匹配患者中，经心尖主动脉瓣植入术和传统主动脉瓣置换术的早期临床结果相似。然而，鉴于残留选择偏倚的可能性，需要进行前瞻性随机试验来充分比较这 2 种主动脉瓣手术的临床结果。
