Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, and Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel.
Am J Cardiol. 2013 May 1;111(9):1330-6. doi: 10.1016/j.amjcard.2013.01.275. Epub 2013 Feb 14.
Transcatheter aortic valve implantation (TAVI) is an emerging technique for the treatment of severe symptomatic aortic stenosis. Little has been reported about the use of different devices and multiple catheter-based options and anesthetic techniques in the same institution. We report the long-term clinical experience in treating patients with severe symptomatic aortic stenosis using TAVI. We analyzed the outcomes of 153 TAVI-treated patients who were followed for ≤2 years. All patients were at very high risk of surgical valve replacement. The Medtronic-CoreValve device was used in 59.5% and the Edwards-SAPIEN device in 40.5% of the patients. The primary end point was death from any cause during follow-up. The mean ± SD patient age was 81.1 ± 6 years, and 62% of the patients were women. The procedural success rate was 97.4%. At 30 days of follow-up, the all-cause mortality was 3.9%. Two-year follow-up data were obtained for 108 patients, with 85.5% survival of treated patients. The 30-day stroke rate was 3.9%. No significant differences in mortality were found when angioplasty was performed before or during TAVI compared with TAVI alone. Multivariate analysis showed that increased baseline creatinine (hazard ratio 1.55, 95% confidence interval 1.01 to 2.42, p = 0.049) and increased logistic European System for Cardiac Operative Risk Evaluation score (hazard ratio 1.03, 95% confidence interval 1.01 to 1.06, p = 0.048) predicted all-cause mortality. In conclusion, the clinical outcome of TAVI is favorable. The use of both procedural devices and multiple techniques in the same institution is feasible and potentially desirable.
经导管主动脉瓣植入术（TAVI）是治疗严重症状性主动脉瓣狭窄的一种新兴技术。关于在同一机构中使用不同的器械和多种基于导管的选择以及麻醉技术的报道较少。我们报告了使用 TAVI 治疗严重症状性主动脉瓣狭窄患者的长期临床经验。我们分析了 153 例接受 TAVI 治疗并随访≤2 年的患者的结果。所有患者均有极高的外科瓣膜置换风险。59.5%的患者使用了美敦力-CoreValve 装置，40.5%的患者使用了爱德华兹-SAPIEN 装置。主要终点是随访期间任何原因导致的死亡。患者的平均年龄±标准差为 81.1±6 岁，62%的患者为女性。手术成功率为 97.4%。在 30 天的随访中，全因死亡率为 3.9%。2 年的随访数据可获得 108 例患者，治疗患者的生存率为 85.5%。30 天的卒中发生率为 3.9%。与单独 TAVI 相比，在 TAVI 之前或期间进行球囊成形术与死亡率无显著差异。多变量分析显示，基线肌酐升高（危险比 1.55，95%置信区间 1.01 至 2.42，p=0.049）和 logistic 欧洲心脏手术风险评估评分升高（危险比 1.03，95%置信区间 1.01 至 1.06，p=0.048）均预测全因死亡率。总之，TAVI 的临床结果是有利的。在同一机构中使用手术器械和多种技术是可行的，并且可能是可取的。
