高危主动脉瓣狭窄患者经导管主动脉瓣植入术与外科瓣膜置换术后30天的结局：一项匹配对照研究。

Thirty-day outcome after transcatheter aortic valve implantation compared with surgical valve replacement in patients with high-risk aortic stenosis: a matched comparison.

作者信息

Stöhr Robert, Dohmen Guido, Herpertz Ralf, Brehmer Kathrin, Aktug Omer, Koos Ralph, Altiok Ertunc, Stegemann Emilia, Autschbach Rüdiger, Marx Nikolaus, Hoffmann Rainer

机构信息

Medical Clinic I, University RWTH Aachen, Germany.

出版信息

Coron Artery Dis. 2011 Dec;22(8):595-600. doi: 10.1097/MCA.0b013e32834d335e.

DOI:10.1097/MCA.0b013e32834d335e

PMID:22009042

Abstract

BACKGROUND

Transcatheter aortic valve implantation (TAVI) has become a therapeutic alternative to surgery for the treatment of severe aortic stenosis in high-surgical risk patients. The aim of this study was to compare 30-day mortality of high-risk patients treated by TAVI versus surgical aortic valve replacement.

METHODS

A total of 175 patients (60 men; mean age, 80±6 years; Euroscore 21±13%) having undergone TAVI were compared with 175 matched patients (76 men; mean age, 79±3 years; Euroscore 17±9%), which have undergone conventional aortic valve replacement and were deemed to be high-risk patients by the cardiothoracic surgeons. Thirty-day mortality and major adverse events were recorded in both groups. Patients' characteristics were analyzed for predictors of mortality in the TAVI group.

RESULTS

Twenty-one patients (12%) in the TAVI group and 13 patients (8%) in the surgical group died within 30 days of the procedure (P=0.165). Two patients (1%) in the TAVI group and one patient (0.5%) in the conventional surgery group had a major stroke (P=1.0). Seven patients (4%) in the TAVI group and 25 patients (14%) in the conventional surgery group required dialysis post procedure (P=0.0013). The average length of stay in the intensive care unit was lower in the TAVI group compared with the conventional surgical group (3.3±3.1 vs. 6.6±10.5 days; P<0.001). Age was the only independent predictor of mortality in the TAVI group (odds ratio=1.009; 95% confidence interval: 1.001-1.018 per additional year; P=0.0186) and in the total study population (odds ratio=1.007; 95% confidence interval: 1.001-1.013 per additional year; P=0.0186).

CONCLUSION

In high-surgical risk patients, TAVI can be performed at a mortality risk comparable with conventional surgery with a reduced length of post interventional intensive care unit stay and less need for dialysis.

摘要

背景

经导管主动脉瓣植入术（TAVI）已成为手术治疗高手术风险患者严重主动脉瓣狭窄的一种替代疗法。本研究的目的是比较接受TAVI治疗的高危患者与接受外科主动脉瓣置换术患者的30天死亡率。

方法

将总共175例接受TAVI的患者（60例男性；平均年龄80±6岁；欧洲心脏手术风险评估系统评分为21±13%）与175例匹配患者（76例男性；平均年龄79±3岁；欧洲心脏手术风险评估系统评分为17±9%）进行比较，这些匹配患者接受了传统主动脉瓣置换术，并且被心胸外科医生视为高危患者。记录两组患者的30天死亡率和主要不良事件。分析患者特征以确定TAVI组中死亡率的预测因素。

结果

TAVI组中有21例患者（12%）在术后30天内死亡，手术组中有13例患者（8%）在术后30天内死亡（P=0.165）。TAVI组中有2例患者（1%）发生严重中风，传统手术组中有1例患者（0.5%）发生严重中风（P=1.0）。TAVI组中有7例患者（4%）术后需要透析，传统手术组中有25例患者（14%）术后需要透析（P=0.0013）。与传统手术组相比，TAVI组在重症监护病房的平均住院时间更短（3.3±3.1天对6.6±10.5天；P<0.001）。年龄是TAVI组（比值比=1.009；95%置信区间：每增加一岁为1.001-1.018；P=0.0186）和整个研究人群（比值比=1.007；95%置信区间：每增加一岁为1.001-1.013；P=0.0186）中死亡率的唯一独立预测因素。