Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
Eur J Cardiothorac Surg. 2013 Jul;44(1):42-7. doi: 10.1093/ejcts/ezs680. Epub 2013 Jan 22.
The present analysis compared clinical and mid-term outcomes of patients with previous cardiac surgery undergoing transapical transcatheter aortic valve implantation (TAVI) with propensity-matched patients undergoing conventional redo aortic valve replacement (cAVR).
Since 2008, 508 patients were treated with TAVI. Fifty-three of these patients presented with a history of cardiac surgery and underwent transapical TAVI using the Edwards SAPIEN bioprosthesis. A propensity-matched control group of 53 patients receiving cAVR was generated out of the hospital's database. The mean age for all the patients was 77.8 ± 4.5 years. The logistic EuroSCORE was 28.4 ± 13.6% in mean, and mean EuroSCORE II was 8.56 ± 3.93%. The mean follow-up time was 245 ± 323 days, which equated to a total of 700 patient-months.
The observed hospital mortality did not differ significantly between TAVI and cAVR (TAVI: 9.4% and cAVR: 5.7%; P = 0.695). Six-month survival was 83.0% for the TAVI and 86.8% for the cAVR patients (P = 0.768). Postoperative bleedings (TAVI: 725 ± 1770 ml and cAVR: 1884 ± 6387; P = 0.022), the need for transfusion (TAVI: 1.7 ± 5.3 vs cAVR: 6.2 ± 13.7 units packed red blood cells (PRBC); P = 0.030), consecutive rethoracotomy (TAVI: 1.9% vs cAVR: 16.9%; P = 0.002) and postoperative delirium (TAVI: 11.5% vs cAVR: 28.3%; P = 0.046) were more common in the cAVR patients. The TAVI patients suffered more frequently from respiratory failure (TAVI: 11.3% vs cAVR: 0.0%; P = 0.017) and mean grade of paravalvular regurgitation (TAVI: 0.8 ± 0.2 vs cAVR: 0.0; P = 0.047). Although primary ventilation time (P = 0.020) and intensive care unit stay (P = 0.022) were shorter in the TAVI patients, mean hospital stay did not differ significantly (P = 0.108).
Transapical TAVI as well as surgical aortic valve replacement provided good clinical results. The pattern of postoperative morbidity and mortality was different for both entities, but the final clinical outcome did not differ significantly. Both techniques can be seen as complementary approaches by means of developing a tailor-made and patient-orientated surgery.
本分析比较了既往心脏手术患者行经心尖经导管主动脉瓣植入术（TAVI）与行传统再次主动脉瓣置换术（cAVR）的临床和中期结果。
自 2008 年以来，共有 508 例患者接受了 TAVI 治疗。其中 53 例有心脏手术史，使用 Edwards SAPIEN 生物瓣行经心尖 TAVI。从医院数据库中生成了 53 例接受 cAVR 的匹配倾向对照组。所有患者的平均年龄为 77.8 ± 4.5 岁。平均 logistic EuroSCORE 为 28.4 ± 13.6%，平均 EuroSCORE II 为 8.56 ± 3.93%。平均随访时间为 245 ± 323 天，共计 700 个患者月。
TAVI 与 cAVR 的院内死亡率无显著差异（TAVI：9.4%，cAVR：5.7%；P=0.695）。TAVI 组和 cAVR 组患者的 6 个月生存率分别为 83.0%和 86.8%（P=0.768）。TAVI 组术后出血量（TAVI：725±1770ml，cAVR：1884±6387ml；P=0.022）、输血需求（TAVI：1.7±5.3 单位 vs cAVR：6.2±13.7 单位浓缩红细胞（PRBC）；P=0.030）、连续开胸手术（TAVI：1.9% vs cAVR：16.9%；P=0.002）和术后谵妄（TAVI：11.5% vs cAVR：28.3%；P=0.046）更常见于 cAVR 患者。TAVI 患者更常发生呼吸衰竭（TAVI：11.3% vs cAVR：0.0%；P=0.017）和更严重的瓣周漏（TAVI：0.8±0.2 级 vs cAVR：0.0 级；P=0.047）。虽然 TAVI 患者的主要通气时间（P=0.020）和重症监护病房停留时间（P=0.022）较短，但平均住院时间无显著差异（P=0.108）。
经心尖 TAVI 和外科主动脉瓣置换术均取得了良好的临床效果。两种方法的术后发病率和死亡率模式不同，但最终临床结果无显著差异。两种技术都可以看作是通过制定一种个体化和以患者为中心的手术来实现互补。
