Department of Cardiothoracic Surgery, King's Health Partners, London, UK.
Eur J Cardiothorac Surg. 2013 Mar;43(3):505-11; discussion 511-2. doi: 10.1093/ejcts/ezs297. Epub 2012 May 30.
Transapical (TA) aortic valve implantation using the Edwards SAPIEN bioprosthesis was commercially introduced in Europe in January 2008. Limited data on the mid-term results are available.
Using data from the SOURCE-Registry (largest consecutive cohort treated using Edwards SAPIEN bioprosthesis in Europe), we report on the mid-term results (≥30 days-2 years) of TA patients.
Between November 2007 and December 2009, a total of 1387 patients from 38 European centres underwent TA aortic valve implantation. The mean follow-up is 14.9 months, with 1004 patients who completed 1 year and 464 patients who completed the 2-year follow-up. The mean age of patients was 80.6 ± 7.1 years with a logistic-EuroSCORE of 27.6%. The main co-morbidities were coronary artery disease (55.8%), previous bypass grafting (25.5%), porcelain aorta (10.2%), previous stroke (6.5%) and peripheral vascular disease (26.4%). A total of 840 patients (60.6%) received a 26 mm and 535 (38.6%) a 23 mm Edwards SAPIEN bioprosthesis. Survivals at 30 days, 1 year and 2 years were 88.7, 73.8 and 65.1%, respectively. Causes of the 276 deaths observed between >30 days and 2-year follow-up were cardiac in 86 patients (31.2%), non-cardiac in 142 (51.4%) and unknown in 48 (17.4%). Cardiac causes of death included heart failure (33.7%), sudden cardiac death (33.7%), myocardial infarct (8.1%), endocarditis (5.8%) and others (18.6%). Non-cardiac deaths were related to pulmonary disease (21.1%), cancer (12.7%), renal failure (11.3%), stroke (10.6%), gastrointestinal disease (7.7%) and others (36.6%). Using univariable and multivariable analyses, logistic EuroSCORE, renal insufficiency and liver diseases were identified as independent predictors of 2-year mortality.
These results demonstrate that in elderly patients with severe co-morbidities, TA aortic valve implantation results in excellent mid-term results. Causes of death during the mid-term follow-up are mainly non-cardiac and related to co-morbidities.
经心尖（TA）植入爱德华兹 SAPIEN 生物瓣于 2008 年 1 月在欧洲开始商业化应用。目前仅有有限的中期结果数据。
利用 SOURCE-Registry （欧洲最大的爱德华兹 SAPIEN 生物瓣治疗连续队列）的数据，我们报告 TA 患者的中期（≥30 天-2 年）结果。
2007 年 11 月至 2009 年 12 月，38 个欧洲中心共 1387 例患者接受 TA 主动脉瓣置换术。平均随访 14.9 个月，1004 例患者完成 1 年随访，464 例患者完成 2 年随访。患者平均年龄 80.6±7.1 岁，逻辑 EuroSCORE 为 27.6%。主要合并症包括冠心病（55.8%）、既往旁路移植术（25.5%）、主动脉瓷化（10.2%）、既往卒中（6.5%）和外周血管疾病（26.4%）。840 例（60.6%）患者植入 26mm 爱德华兹 SAPIEN 生物瓣，535 例（38.6%）植入 23mm 爱德华兹 SAPIEN 生物瓣。30 天、1 年和 2 年生存率分别为 88.7%、73.8%和 65.1%。>30 天至 2 年随访期间，276 例死亡患者的死亡原因为心脏（86 例，31.2%）、非心脏（142 例，51.4%）和原因不明（48 例，17.4%）。心脏原因死亡包括心力衰竭（33.7%）、心源性猝死（33.7%）、心肌梗死（8.1%）、心内膜炎（5.8%）和其他（18.6%）。非心脏原因死亡与肺部疾病（21.1%）、癌症（12.7%）、肾衰竭（11.3%）、卒中（10.6%）、胃肠道疾病（7.7%）和其他（36.6%）相关。单变量和多变量分析显示，逻辑 EuroSCORE、肾功能不全和肝脏疾病是 2 年死亡率的独立预测因素。
这些结果表明，在患有严重合并症的老年患者中，TA 主动脉瓣置换术可获得优异的中期结果。中期随访期间的死亡原因主要为非心脏性，与合并症相关。
