Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str 6, 18057 Rostock, Germany.
BMC Cardiovasc Disord. 2012 Sep 24;12:80. doi: 10.1186/1471-2261-12-80.
Nonagenarians are mostly denied from different therapeutic strategies due to high comorbidity index and risk-benefit calculation. We present the results of nonagenarians with high comorbidity index not eligible for conventional aortic valve surgery undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve system.
Our retrospective analysis include baseline parameters, procedural characteristics, morbidity, mortality as well as twelve-lead surface ECG and echocardiographic parameters which were revealed preinterventionally, at hospital discharge and at 30-day follow-up. Clinical follow-up was performed 6 months after TAVI.
Out of 158 patients 11 nonagenarians with a mean age of 92.6 ± 1.3 years suffering from severe aortic valve stenosis and elevated comorbidity index (logistic EuroSCORE of 32.0 ± 9.5%, STS score 25.3 ± 9.7%) underwent TAVI between January 2008 and January 2011 using the third-generation percutaneous self-expanding CoreValve prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.6 ± 0.2 cm(2) with a mean and peak pressure gradient of 60.2 ± 13.1 mmHg and 91.0 ± 27.4 mmHg, respectively. The 30-day follow up all cause and cardiovascular mortality was 27.3% and 9.1%, respectively. One major stroke (9.1%), 2 pulmonary embolisms (18.2%), 1 periprocedural (9.1%) and 1 (9.1%) spontaneous myocardial infarction occured. Life-threatening or disabling bleeding occurred in 2 cases (18.2%), and minor bleeding in 7 cases (63.6%). Mean severity of heart failure according to NYHA functional class improved from 3.2 ± 0.8 to 1.36 ± 0.5 while mean AVA increased from 0.6 ± 0.2 cm(2) to 1.8 ± 0.2 cm(2). At 6-months follow-up 8 patients (72.7%) were alive without any additional myocardial infarction, pulmonary embolism, bleeding, or stroke as compared to 30-day follow-up.
Our case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with CoreValve.
由于高合并症指数和风险效益计算，大多数 90 岁以上的患者被排除在不同的治疗策略之外。我们报告了不符合常规主动脉瓣手术标准的高合并症指数的 90 岁以上患者接受 CoreValve 系统经导管主动脉瓣植入术（TAVI）的结果。
我们的回顾性分析包括基线参数、手术特征、发病率、死亡率以及术前、出院时和 30 天随访时的 12 导联体表心电图和超声心动图参数。TAVI 后 6 个月进行临床随访。
在 158 例患者中，有 11 例 90 岁以上的患者，平均年龄为 92.6±1.3 岁，患有严重的主动脉瓣狭窄和升高的合并症指数（逻辑 EuroSCORE 为 32.0±9.5%，STS 评分为 25.3±9.7%），在 2008 年 1 月至 2011 年 1 月期间使用第三代经皮自扩张 CoreValve 假体接受了 TAVI。基线经胸超声心动图报告平均主动脉瓣面积（AVA）为 0.6±0.2cm2，平均和峰值压力梯度分别为 60.2±13.1mmHg 和 91.0±27.4mmHg。30 天随访的全因和心血管死亡率分别为 27.3%和 9.1%。1 例（9.1%）发生重大卒中，2 例（18.2%）发生肺栓塞，1 例（9.1%）发生围手术期心肌梗死，1 例（9.1%）发生自发性心肌梗死。2 例（18.2%）发生危及生命或致残性出血，7 例（63.6%）发生轻微出血。根据纽约心脏协会（NYHA）功能分级，心力衰竭的严重程度从 3.2±0.8 改善至 1.36±0.5，平均 AVA 从 0.6±0.2cm2 增加至 1.8±0.2cm2。在 6 个月的随访中，与 30 天随访相比，8 例（72.7%）患者存活，无其他心肌梗死、肺栓塞、出血或卒中。
我们的病例系列表明，即使合并症指数较高，接受 CoreValve 治疗的 90 岁以上患者的临床终点和瓣膜相关结果仍然相对较好。
