Division of Cardiac Surgery, Centro Gallucci, University of Padova Medical School, Padova, Italy.
Eur J Cardiothorac Surg. 2012 Sep;42(3):480-5. doi: 10.1093/ejcts/ezs027. Epub 2012 Feb 20.
Redo cardiac surgery has an increased risk of morbidity and mortality when compared with the initial operation. The aim of this study was to assess the impact of previous cardiac operations on patients undergoing transapical aortic valve implantation (TA-TAVI).
We analysed data from 566 patients included in the Italian Registry of Transapical Aortic Valve Implantation who underwent TA-TAVI implantation with the Sapien valve (Edwards Lifesciences, Irvine, CA, USA) from April 2008 through May 2011. Of these, 110 patients (19.4%) had already undergone at least one previous cardiac operation with opening of the pericardium (group R) while for 456 patients (80.6%) TA-TAVI was the first cardiac procedure (group F). Data were prospectively collected at each of the 20 participating centres and then sent to a central database for storage and analysis.
Preoperative logistic EuroSCORE was higher in group R (35 ± 18.6 vs. 23.5 ± 11.9%; P < 0.001). Hospital mortality occurred in eight (7.2%) and 36 (7.9%) patients in groups R and F, respectively (P = 0.8). Mean follow-up was 10.4 ± 7.9 months (range: 1-34). Overall 2-year Kaplan-Meier survival was 64.2 ± 9.8 and 75.4 ± 3.5% in groups R and F, respectively (P = 0.69). Incidence of operative complications, postoperative bleeding, pacemaker implantation, myocardial infarction and stroke did not show statistically significant differences between groups. The univariate analysis showed that arterial hypertension, logistic EuroSCORE, porcelain aorta, left ventricular ejection fraction and previous percutaneous coronary interventions were significantly associated with 30-day mortality in group R.
According to our data, patients undergoing TAVI with previous cardiac operations have a higher preoperative risk profile but have similar outcomes when compared with patients undergoing a first operation. In these subset of patients, TAVI is a promising therapeutic option.
与初次手术相比，再次心脏手术的发病率和死亡率更高。本研究旨在评估先前的心脏手术对接受经心尖主动脉瓣植入术（TA-TAVI）的患者的影响。
我们分析了 2008 年 4 月至 2011 年 5 月期间接受 Sapien 瓣膜（爱德华兹生命科学公司，加利福尼亚州欧文市）经心尖主动脉瓣植入术的 566 例患者的意大利经心尖主动脉瓣植入术登记处的数据。其中，110 例患者（19.4%）至少进行过一次开胸心包的心脏手术（R 组），而 456 例患者（80.6%）是首次心脏手术（F 组）。数据由 20 个参与中心前瞻性收集，然后发送到中央数据库进行存储和分析。
R 组的术前逻辑 EuroSCORE 更高（35 ± 18.6 比 23.5 ± 11.9%；P < 0.001）。R 组和 F 组的院内死亡率分别为 8 例（7.2%）和 36 例（7.9%）（P = 0.8）。平均随访时间为 10.4 ± 7.9 个月（范围：1-34 个月）。R 组和 F 组的 2 年 Kaplan-Meier 生存率分别为 64.2 ± 9.8%和 75.4 ± 3.5%（P = 0.69）。两组之间手术并发症、术后出血、起搏器植入、心肌梗死和卒中的发生率无统计学差异。单因素分析显示，动脉高血压、逻辑 EuroSCORE、瓷主动脉、左心室射血分数和先前的经皮冠状动脉介入治疗与 R 组 30 天死亡率显著相关。
根据我们的数据，与初次手术相比，再次心脏手术的患者术前风险更高，但结局相似。在这些患者亚组中，TAVI 是一种有前途的治疗选择。
