Van Mieghem Nicolas M, van der Boon Robert M, Nuis Rutger-Jan, Schultz Carl, van Geuns Robert-Jan, Serruys Patrick W, Kappetein Arie-Pieter, van Domburg Ron T, de Jaegere Peter P
Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Catheter Cardiovasc Interv. 2014 Jun 1;83(7):E277-82. doi: 10.1002/ccd.24597. Epub 2013 Nov 30.
To evaluate survival and cause of death in a consecutive patient cohort undergoing Transcatheter Aortic Valve implantation (TAVI).
TAVI is a valid treatment option in patients with severe Aortic Stenosis (AS) who are deemed at (very) high operative risk. Because of (non-)cardiac comorbidities life expectancy in this patient, population is reduced when compared with the general population.
Consecutive patients with symptomatic aortic stenosis undergoing TAVI between November 2005 and December 2011 were included. (1) Survival status was obtained from the Dutch Civil Registry, (2) cause of death was derived by reviewing hospital charts, and (3) contacting referring physicians and patients' general practitioners.
Two hundred and thirty-seven consecutive patients were included with an overall all-cause mortality of 31% at a median follow up of 13 months (IQR 2-24 months). Four patients (1.6%) died < 48 hr of the TAVI procedure, and another 16 patients died up to the 30-day interval representing an all-cause 8.4% 30-day mortality. Between 30 days and 1-year another 30 patients died. Twenty-four patients died >1 year post TAVI. The predominant cause of death >48 hr post TAVI was noncardiac. One third of these deaths were due to sepsis/infection, one-fifth to cancer and stroke in 16%.
In our series of AS patients undergoing TAVI, the cause of death >48 hr post procedure was predominantly noncardiac at every time interval. Mortality was driven by sepsis/infection, cancer, and stroke. Rigorous patient selection may improve outcome after TAVI.
评估接受经导管主动脉瓣植入术（TAVI）的连续患者队列的生存率和死亡原因。
TAVI是严重主动脉瓣狭窄（AS）且被认为手术风险（非常）高的患者的一种有效治疗选择。由于（非）心脏合并症，该患者群体的预期寿命与一般人群相比有所缩短。
纳入2005年11月至2011年12月期间接受TAVI的有症状主动脉瓣狭窄的连续患者。（1）生存状态从荷兰民事登记处获取，（2）死亡原因通过查阅医院病历得出，（3）联系转诊医生和患者的全科医生。
共纳入237例连续患者，中位随访13个月（四分位间距2 - 24个月）时全因死亡率为31%。4例患者（1.6%）在TAVI术后<48小时死亡，另有16例患者在30天内死亡，全因30天死亡率为8.4%。30天至1年期间另有30例患者死亡。24例患者在TAVI术后>1年死亡。TAVI术后>48小时的主要死亡原因是非心脏性的。这些死亡中有三分之一是由于败血症/感染，五分之一是由于癌症，16%是由于中风。
在我们这组接受TAVI的AS患者中，术后>48小时的死亡原因在每个时间间隔主要是非心脏性的。死亡率由败血症/感染、癌症和中风驱动。严格的患者选择可能会改善TAVI后的结局。
