Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Switzerland.
Eur Heart J. 2013 Jul;34(25):1894-905. doi: 10.1093/eurheartj/eht086. Epub 2013 Mar 13.
Transcatheter aortic valve implantation (TAVI) is an established treatment alternative to surgical aortic valve replacement in high-risk and inoperable patients and outcomes among patients with estimated low or intermediate risk remain to be determined. The aim of this study was to assess clinical outcomes among patients with estimated low or intermediate surgical risk undergoing TAVI.
Between August 2007 and October 2011, 389 consecutive patients underwent TAVI and were categorized according to the Society of Thoracic Surgeons (STS) score into low (STS < 3%; n = 41, 10.5%), intermediate (STS ≥3% and ≤8%, n = 254, 65.3%), and high-risk (STS > 8%; n = 94, 24.2%) groups for the purpose of this study. Significant differences were found between the groups (low risk vs. intermediate risk vs. high risk) for age (78.2 ± 6.7 vs. 82.7 ± 5.7 vs. 83.7 ± 4.9, P < 0.001), body mass index (28.1 ± 6.1 vs. 26.5 ± 4.9 vs. 24.4 ± 4.6, P < 0.001), chronic renal failure (34 vs. 67 vs. 90%, P < 0.001), all-cause mortality at 30 days (2.4 vs. 3.9 vs. 14.9%, P = 0.001), and all-cause mortality at 1 year (10.1 vs. 16.1 vs. 34.5%, P = 0.0003). No differences were observed with regards to cerebrovascular accidents and myocardial infarction during 1-year follow-up.
In contemporary practice, TAVI is not limited to inoperable or STS-defined high-risk patients and should be guided by the decision of an interdisciplinary Heart Team. Compared with patients at calculated high risk, well-selected patients with STS-defined intermediate or low risk appear to have favourable clinical outcomes.
经导管主动脉瓣置换术（TAVI）是高危和不可手术患者的一种成熟的替代外科主动脉瓣置换术的治疗选择，而风险估计低或中危患者的结局仍有待确定。本研究旨在评估风险估计低或中危的 TAVI 患者的临床结局。
2007 年 8 月至 2011 年 10 月，连续 389 例患者接受 TAVI，并根据胸外科医师学会（STS）评分分为低危（STS<3%；n=41，10.5%）、中危（STS≥3%且≤8%；n=254，65.3%）和高危（STS>8%；n=94，24.2%）组进行分组。在年龄（78.2±6.7 岁 vs. 82.7±5.7 岁 vs. 83.7±4.9 岁，P<0.001）、体重指数（28.1±6.1 千克/平方米 vs. 26.5±4.9 千克/平方米 vs. 24.4±4.6 千克/平方米，P<0.001）、慢性肾衰竭（34% vs. 67% vs. 90%，P<0.001）、30 天全因死亡率（2.4% vs. 3.9% vs. 14.9%，P=0.001）和 1 年全因死亡率（10.1% vs. 16.1% vs. 34.5%，P=0.0003）方面，各组间存在显著差异。在 1 年的随访中，各组间的脑血管意外和心肌梗死发生率无差异。
在当代实践中，TAVI 不仅限于不能手术或 STS 定义的高危患者，应根据跨学科心脏团队的决策进行指导。与计算出的高危患者相比，经选择的 STS 定义的中危或低危患者似乎具有良好的临床结局。
