D'Onofrio Augusto, Alfieri Ottavio R, Cioni Micaela, Alamanni Francesco, Fusari Melissa, Tarzia Vincenzo, Rizzoli Giulio, Gerosa Gino
Division of Cardiac Surgery, University of Padua, Padua, Italy.
Interact Cardiovasc Thorac Surg. 2013 May;16(5):608-11. doi: 10.1093/icvts/ivs550. Epub 2013 Jan 29.
The aim of this retrospective multicenter study was to assess how the development of transcatheter aortic valve implantation (TAVI) influenced the characteristics and outcomes of patients undergoing aortic valve procedures.
We reviewed 1395 patients who underwent isolated surgical aortic valve replacement (SAVR) or TAVI in three centres with a high-volume TAVI programme. Patients were divided into two groups: 'Pre-TAVI' (395 patients, 28.3%) and 'Post-TAVI' (1000 patients, 71.7%) operated on before and after the introduction of TAVI into clinical practice. We evaluated age, logistic EuroSCORE I (LES) and hospital mortality according to time periods and the procedure performed, whether SAVR or TAVI.
'Post-TAVI' patients were older (78.2 ± 7.8 vs 76.8 ± 6.7 years; P = 0.002) and with a significantly higher LES (17.8 ± 14.7 vs 9.1 ± 9.2%; P < 0.001) than 'Pre-TAVI' patients. Hospital mortality was not significantly different between groups ('Pre-TAVI' vs 'Post-TAVI': 2 vs 3.4%; P = 0.17). Of the 1000 'Post-TAVI' patients, 605 (60.5%) underwent TAVI and 395 (39.5%), SAVR. Patients undergoing TAVI were older (79.9 ± 7.1 vs 75.5 ± 9.2 years; P < 0.001) and with a higher LES (22.9 ± 15.3 vs 9.7 ± 9.3%; P < 0.001) than 'Post-TAVI' SAVR patients, but their hospital mortality was similar (3.9 vs 2.5%; P = 0.22). LES was similar between 'Pre-TAVI' and 'Post-TAVI' SAVR patients (9.1 ± 9.2 vs 9.7 ± 9.3%; P = 0.26). Furthermore, we did not find significant differences in the overall hospital mortality between SAVR and TAVI patients: 2.3 vs 3.9%, P = 0.08.
This analysis shows that the development of TAVI has caused an increase in the preoperative risk profile of patients scheduled for aortic valve procedures (SAVR or TAVI) without increasing hospital mortality.
这项回顾性多中心研究旨在评估经导管主动脉瓣植入术（TAVI）的发展如何影响接受主动脉瓣手术患者的特征和预后。
我们回顾了在三个开展大量TAVI项目的中心接受单纯外科主动脉瓣置换术（SAVR）或TAVI的1395例患者。患者分为两组：“TAVI术前”组（395例患者，28.3%）和“TAVI术后”组（1000例患者，71.7%），分别在TAVI引入临床实践之前和之后接受手术。我们根据时间段以及所进行的手术（SAVR或TAVI）评估了年龄、逻辑EuroSCORE I（LES）和医院死亡率。
“TAVI术后”组患者比“TAVI术前”组患者年龄更大（78.2±7.8岁 vs 76.8±6.7岁；P = 0.002），LES显著更高（17.8±14.7 vs 9.1±9.2%；P < 0.001）。两组之间的医院死亡率无显著差异（“TAVI术前”组 vs “TAVI术后”组：2% vs 3.4%；P = 0.17）。在1000例“TAVI术后”患者中，605例（60.5%）接受了TAVI，395例（39.5%）接受了SAVR。接受TAVI的患者比“TAVI术后”接受SAVR的患者年龄更大（79.9±7.1岁 vs 75.5±9.2岁；P < 0.001），LES更高（22.9±15.3 vs 9.7±9.3%；P < 0.001），但他们的医院死亡率相似（3.9% vs 2.5%；P = 0.22）。“TAVI术前”和“TAVI术后”接受SAVR的患者之间LES相似（9.1±9.2 vs 9.7±9.3%；P = 0.26）。此外，我们未发现SAVR和TAVI患者的总体医院死亡率有显著差异：2.3% vs 3.9%，P = 0.08。
该分析表明，TAVI的发展导致计划接受主动脉瓣手术（SAVR或TAVI）的患者术前风险状况增加，但未增加医院死亡率。
