缺乏经导管植入术与主动脉瓣置换术选择的明确适应证标准。
Lack of definite indication criteria for choosing between transcatheter implantation and surgical replacement of the aortic valve.
机构信息
Department of Cardiothoracic Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
出版信息
J Cardiovasc Med (Hagerstown). 2013 Feb;14(2):158-63. doi: 10.2459/JCM.0b013e32834eed0d.
AIMS
Age over 75 years and logistic Euroscore over 20% have been jointly proposed by European scientific associations as the criteria for aortic valve stenosis patients to be considered 'high-risk' for surgical aortic valve replacement (AVR) and candidates for transcatheter aortic valve implantation (TAVI). We aimed to verify traditional AVR outcomes in the presence of the above criteria.
METHODS
Between January 2001 and January 2011, 180 patients with severe aortic valve stenosis (mean aortic valve area = 0.4±0.1 cm/m), with age range 75-88 years (mean 78.2±3), logistic Euroscore between 4.5 and 40% (mean 12.6±7.4%), underwent surgical AVR. The patient population was divided into group A (118 patients between 75 and 79 years of age), further divided into subgroups A1 (76 patients) and A2 (42 patients) with logistic Euroscore, respectively, less than 20% and at least 20%; and group B (62 patients between 80 and 88 years of age), subdivided into B1 (34 patients) and B2 (28 patients) with logistic Euroscore, respectively, less than 20% and at least 20%. Hospital outcomes were retrospectively evaluated. Univariate and multivariate analyses, including age and logistic Euroscore, were performed to individuate predictors of hospital mortality.
RESULTS
Overall observed/expected mortality ratio was 0.4. Hospital mortality was 5.3% in group A1, 4.8% in A2, 5.9% in B1, 3.6% in B2 (P=NS). Mortality with age over 75 and Euroscore at least 20% was 4.3%. As regards postoperative morbidity, atrio-ventricular bock indicating pacemaker implantation occurred in four patients, pneumonia in three, stroke in two, perioperative myocardial infarction in one. Age and Euroscore were not independent predictors of mortality, morbidity or composite endpoint in multivariable analysis.
CONCLUSION
Age and logistic Euroscore might be inadequate criteria for the identification of patients with severe aortic stenosis unsuitable for AVR and addressable to TAVI.
目的
欧洲科学协会共同提出，年龄超过 75 岁和 logistic Euroscore 超过 20%是主动脉瓣狭窄患者接受主动脉瓣置换术（AVR）和经导管主动脉瓣植入术（TAVI）的高风险的标准。我们旨在验证存在上述标准时传统 AVR 结果。
方法
2001 年 1 月至 2011 年 1 月，180 例严重主动脉瓣狭窄患者（平均主动脉瓣口面积为 0.4±0.1 cm/m），年龄 75-88 岁（平均 78.2±3），logistic Euroscore 在 4.5%至 40%之间（平均 12.6±7.4%），接受了手术 AVR。患者人群分为 A 组（118 例年龄在 75-79 岁之间），进一步分为 A1 组（76 例）和 A2 组（42 例），logistic Euroscore 分别小于 20%和至少 20%；和 B 组（62 例年龄在 80-88 岁之间），进一步分为 B1 组（34 例）和 B2 组（28 例），logistic Euroscore 分别小于 20%和至少 20%。回顾性评估住院结局。进行单变量和多变量分析，包括年龄和 logistic Euroscore，以确定住院死亡率的预测因子。
结果
总体观察/预期死亡率比为 0.4。A1 组的院内死亡率为 5.3%，A2 组为 4.8%，B1 组为 5.9%，B2 组为 3.6%（P=NS）。75 岁以上和 Euroscore 至少 20%的年龄死亡率为 4.3%。至于术后发病率，房室传导阻滞需要植入起搏器的有 4 例，肺炎 3 例，中风 2 例，围手术期心肌梗死 1 例。年龄和 Euroscore 不是多变量分析中死亡率、发病率或复合终点的独立预测因子。
结论
年龄和 logistic Euroscore 可能不足以识别不适合 AVR 且适合 TAVI 的严重主动脉瓣狭窄患者。
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